CPT 99203: New patient, moderate
What this code means, what it should cost, and how to dispute an overcharge.
Fair Price Reference
What is CPT 99203?
CPT 99203 (New patient, moderate) is a office visit billing code defined by the American Medical Association. It's used to bill your insurance or you directly for this service.
What CPT 99203 should cost
The Centers for Medicare & Medicaid Services (CMS) pays approximately $109 for CPT 99203 under the 2025 Physician Fee Schedule. This is what the federal government has determined is a reasonable payment for this service.
Private insurance typically pays 1.2–1.8x Medicare rates ($131–$196). Hospital chargemaster prices for CPT 99203 often range from $150 to $450 — a markup of 1.4x to 4.1x over Medicare.
Common overcharges on CPT 99203
Upcoding from 99213 to 99214 or 99215 without documented medical decision-making complexity. Adding modifier 25 to charge separately for a minor procedure that should be bundled.
About Office Visit billing
Evaluation & management (E&M) codes for office visits are the most frequently billed codes in medicine. They are also a leading source of upcoding — where a provider bills a higher-complexity level than the visit actually supports.
Request the office visit note. Compare the documented history, exam, and medical decision-making against the 2021 AMA E&M guidelines. If the documentation doesn't support the billed level, request a downcode.
How to dispute a CPT 99203 overcharge
- Request the itemized bill. You are entitled to a detailed line-by-line bill showing every CPT code billed. Ask in writing.
- Compare to Medicare allowable. If the charge exceeds 150% of Medicare ($164), you have grounds to dispute.
- Request documentation. For E&M codes, ask for the visit note. For procedures, ask for the operative report. The documentation must justify the code billed.
- Send a formal dispute letter. Cite the specific discrepancy between the documentation and the code. Reference Medicare rates and NCCI edits where applicable.
- Follow up in writing. Give the provider 30 days to respond. If they don't, escalate to the state attorney general and insurance commissioner.
Got CPT 99203 on your bill?
Upload your bill. We scan every line for overcharges, upcoding, and improper unbundling — then generate a dispute letter backed by federal law. Free for uninsured and veterans.