CPT 99213
Office visit, established patient, level 3
A level 3 office visit for an established patient. Your statement may shorten this to 'OV EST PT LEV 3' or 'EST PT LEVEL 3'. The code describes the visit's billing level, not how serious your condition is. Ask the office to confirm that the abbreviation on your statement refers to 99213.
Billed to Medicare
$189
What providers submitted, on average, for this code in an office.
Medicare accepted
$85
What Medicare treated as payable. Not a commercial rate or a cash price.
The gap
2.2x
How many times the accepted amount the billed figure was.
National averages from the Centers for Medicare & Medicaid Services, 2024 data, retrieved 2026-09-14. Medicare fee-for-service, physician and practitioner claims only. The hospital's own charge for the same code is separate and is usually higher. Based on 64,778,139.1 services.
Of the 4 doctor visits codes on this site with CMS figures, this one has the narrowest gap between billed and accepted. The widest is Initial hospital care, high complexity at 3.4x.
Where this line goes wrong
Time or decision making
The office can select the level using medical decision making or qualifying clinician time on the date of the visit. When time is used for 99213, the range is 20 to 29 minutes; this can include work outside the exam room. A short face-to-face visit alone does not prove the code is wrong. Ask which method supported the level.
Facility fee in a hospital-owned clinic
If the practice is owned by a hospital, you may get a second charge for the clinic (G0463 or a revenue code) on top of the doctor's visit. That is why the same visit costs more after a practice is bought by a hospital.
A preventive visit that became a problem visit
An annual physical with a problem discussed can be billed as both the preventive code and a 99213 with a modifier. The second charge is legitimate only if the problem needed separate work.
Want to know if this line is right on your own bill? Upload it to a free mediloop account. An automatic first look reads the charges and shows what looks worth questioning, usually in about a minute.
Check my bill for freeCheck it, then ask
- 1
Please confirm whether my level 3 office visit was coded using medical decision making or total clinician time. If time was used, what qualifying work and total minutes were documented on that date?
- 2
If there is a second facility charge, ask whether the practice is hospital-owned and whether you were told.
- 3
If a physical turned into a paid visit, ask what separate problem was addressed.
The full walkthrough for this kind of bill: Your bill came in above the estimate.
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People also ask
What is the difference between 99213 and 99214?
99213 corresponds to low medical decision making; 99214 corresponds to moderate medical decision making. When time determines the code, the ranges are 20 to 29 and 30 to 39 minutes respectively. The documented work determines the level, not the price or face-to-face duration alone.
Sources
This page explains a billing code in general terms. It is not a coding, legal or medical opinion about your bill, and the code descriptions are mediloop's own plain-English summaries, not the official CPT descriptors, which are owned by the American Medical Association. Whether a charge was correct depends on the record of your visit and your payer's rules.