CLV IntelligenceReimbursement Policy Monitoring

CPT procedure code

99213 — Office/outpatient visit, established patient, low complexity

E/MCPT

Medicare payment

$95.19

2026 Physician Fee Schedule · non-facility

Source: CMS Physician Fee Schedule (PPRRVU 2026). CMS fee schedules ↗ · PFS status indicator A

National amount before geographic adjustment. Your MAC's locality rate will differ.

Code definition

Code

99213

Code system

CPT (Current Procedural Terminology)

Description

Office/outpatient visit, established patient, low complexity

Category

E/M

Short description sourced from CMS publicly available fee schedule data. Full CPT descriptions are copyright AMA. Not a substitute for the official CPT codebook.

Policy activity for CPT 99213

CLV Intelligence is tracking 1 policy change that cite CPT 99213 most recently on 2026-06-02, drawn from 1 policy update. The changes span OIG Work Plan.

policy update
1

Counts reflect the source documents CLV has matched to CPT 99213 to date; each links to the government publication that is authoritative. Monitored daily from CMS, the Federal Register, and Medicare Administrative Contractor publications.

Policy changes matched to 99213

Matched to this code by CLV analysis of each policy. The linked source document is authoritative.

Fraud Risk and Heightened Scrutiny

OIG Work Plan · FRAUD-RISK-AND-HEIGHTENED-SCRUTINY

Government source· Federal Registerverify ↗
Routine

Full analysis available with a CLV subscription.

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Audit documentation

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Related CPT codes (992xx)

99202E/M

Office/outpatient visit, new patient, low complexity

99203E/M

Office/outpatient visit, new patient, moderate complexity

99204E/M

Office/outpatient visit, new patient, moderate-high complexity

99205E/M

Office/outpatient visit, new patient, high complexity

99211E/M

Office/outpatient visit, established patient, minimal

99212E/M

Office/outpatient visit, established patient, straightforward

99214E/M

Office/outpatient visit, established patient, moderate complexity

99215E/M

Office/outpatient visit, established patient, high complexity

99221E/M

Initial hospital inpatient care, low complexity

99222E/M

Initial hospital inpatient care, moderate complexity

99223E/M

Initial hospital inpatient care, high complexity

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