CPT 99203: New Patient Office Visit, Low Complexity
Medicare pays $121 and commercial payers pay $148 on average nationally for this procedure.
CPT code 99203 describes an outpatient new patient office or other outpatient visit for evaluation and management with a low level of medical decision making or when the clinician documents 30 or more minutes of total encounter time on a single date; typical site of service is the office outpatient clinic and the service type is new patient E/M office visit.
For related coverage guidance, see recent payer policy updates: Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA), Cardiovascular Disease Risk Assessment, Biomarkers for Myocardial Infarction and Chronic Heart Failure.
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National Reimbursement Benchmarks
Commercial averages sit above Medicare: BUCA’s mean commercial rate of $148.5 compares with Medicare’s mean of $121, a gap of $27.5 that places BUCA about 23% higher than the Medicare national average for CPT 99203. Blue Cross Blue Shield’s mean ($159.8) and UnitedHealth Group’s mean ($145.8) are also above Medicare, while Aetna ($128.8) and Cigna ($125.6) are closer to Medicare’s level.
Dispersion varies materially by payer. Calculating interquartile spreads (P75 minus P25) shows Blue Cross Blue Shield and UnitedHealth Group as most variable—BCBS spread $67.6 and UnitedHealth spread $78.0—indicating wider middle-range differences. Aetna and Cigna are tighter with spreads of $82.7 and $84.0 respectively in absolute terms, but relative to their medians they present less dispersion; BUCA’s IQR is $74.0 and Medicare’s IQR is only $10, reflecting the narrowest central-range variation.