CPT 99213: $98

Where CPT 99213 commonly shows up on a bill

Common patterns to look at when reviewing this code:

• 01.A 10-minute follow-up coded as a moderate-complexity visit (99214) instead of low (99213).
• 02.A telehealth visit coded under in-person codes when the encounter was virtual.
• 03.An established patient billed as new (codes 99202–99205 are reserved for first-visit-in-3-years patients).

These patterns are documented in CMS billing guidance, the National Correct Coding Initiative (NCCI) edits, and Office of Inspector General audit reports. None of them are accusations about any specific bill or facility — they’re the checks that exist because the patterns themselves exist.

How to check CPT 99213 on your bill

A few quick checks you can run yourself:

• 01.Find your visit code (99211–99215) on the itemized bill. 99214 and 99215 claim moderate-to-high complexity.
• 02.Match that level to what your visit actually involved. A quick, routine check-in coded high is worth asking about.
• 03.If anything else happened that day — a shot, a small procedure — check whether the visit was billed on top of it.

What hospitals charge for CPT 99213

Distribution across 557 US hospitals reporting this code under federal Hospital Price Transparency rules (45 CFR §180.50). Gross charges shown here are the chargemaster prices — the starting point before insurance discounts or self-pay reductions. Medicare allowed amount: $98.

Range across all reporting hospitals: $17 to $27,104. That’s a 1594× spread for the same procedure code — one of the reasons federal price-transparency rules exist.

Sorted by published chargemaster price only. Chargemaster is the starting point before insurance discounts or self-pay reductions; the actual amount any specific patient pays depends on case mix, charity-care policy, and insurance contract.

Bundling check for CPT 99213

CPT 99213appears in known CMS National Correct Coding Initiative (NCCI) bundling rules. When two codes in a pair are billed separately for the same date of service, the lesser code is generally not separately payable — worth a look if you see both on your bill.

• CPT 99213+CPT 20610Modifier required to separate

  An office visit is not separately billable from a same-day major joint injection unless the E/M was for a clearly distinct issue. -25 modifier required to override.

• CPT 99213+CPT 10060Modifier required to separate

  An office visit is not separately billable from a same-day abscess incision and drainage unless the E/M addressed a clearly distinct issue. -25 modifier required.

• CPT 99213+CPT 45378Modifier required to separate

  An office visit on the same day as a screening colonoscopy (45378) is not separately billable unless the E/M addressed a clearly distinct issue beyond pre-procedure consent.

• CPT 99213+CPT 11102Modifier required to separate

  Skin biopsy (11102) and same-day office visit (99213) — OIG audits find inappropriate -25 modifier use in 30-60% of these pairs. The medical record must document two distinct services, not just routine pre-biopsy assessment.

• CPT 99213+CPT 17000Modifier required to separate

  Premalignant lesion destruction (17000) and same-day office visit (99213) — routine pre-procedure evaluation does not justify a separate E/M. -25 modifier and a clearly distinct issue required.

• CPT 99213+CPT 20605Modifier required to separate

  Intermediate joint injection (20605) and same-day office visit (99213) — routine pre-injection assessment does not justify a separate E/M. -25 modifier required.

General information from the CMS NCCI program — not an accusation about any specific bill, and not legal or billing advice for your situation. Whether a pair is billed correctly depends on the documentation behind it.

Common dispute patterns for CPT 99213

Patterns frequently associated with this code. Each links to a federally-grounded dispute scenario with the relevant statute, sample language, and step-by-step detection guide.

• Coding errors

  Wrong place-of-service code

  Place-of-service codes determine whether Medicare and most insurance pay the higher facility rate or the lower non-facility rate. A code mismatch can inflate a bill substantially.

• Coding errors

  Modifier-25 abuse

  Modifier 25 lets a provider bill an office visit alongside a procedure on the same day, but only when the visit is a 'significant, separately identifiable' service. The OIG has repeatedly flagged inappropriate use.

• Coding errors

  Annual physical billed as a sick visit

  Preventive visits (annual physicals, well-child checks) are required by the ACA to be $0 cost-share when in-network. When the same visit gets coded with a diagnostic code, you may owe a copay or coinsurance you weren't expecting.

Related codes

Codes in the same numerical neighborhood — often appear together on the same bill or get billed in place of each other:

• CPT 99202$77

  Office visit, new patient, straightforward

• CPT 99203$120

  Office visit, new patient, low complexity

• CPT 99204$182

  Office visit, new patient, moderate complexity

• CPT 99205$242

  Office visit, new patient, high complexity

• CPT 99211$25

  Office visit, established patient, minimal

• CPT 99212$61

  Office visit, established patient, straightforward

Common questions about CPT 99213