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Q4 2026 starts Oct 1, 2026. Preview changes

The national office (non-facility) amount is unchanged. Preview this code · Quarterly changes

CPT 99203

New Patient Office Visit

National PFS baseline · Q3 2026

99203 · Current

GPCIs 1.000 · Participating · Before sequestration

Find the locality-adjusted allowed amount

Nationally priced under PFS, using the RVU formula.

The national PFS baseline is $117.57 for CPT 99203 in the office (non-facility) setting and $71.48 in a facility under the Q3 2026 Physician Fee Schedule, effective July 2026. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded.

Calculation evidence

Physician relative value file (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 12,949)

Compact facts

Why are the facility and non-facility amounts different?

Only the practice-expense RVU changes with the setting. For 99203 it's 1.76 RVUs in the office versus 0.38 in a facility—the whole $46.09 gap between $117.57 and $71.48. In an office the practice bears the overhead, so Medicare pays more; in a hospital or ASC the facility bills its own fee, so the professional payment is lower. See facility vs non-facility.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov).

About this code

Also known as New patient office visit

A patient's first visit with this clinician, covering history, examination, and an initial plan for a straightforward problem. Medicare reported 8.7 million services under this code in CY2024.

Plain-language context only—not the official CPT descriptor and not coding guidance

What could change this amount? Copy link

Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.

Service location and setting · Participation and payment shares

Facility/non-facility Applies NCCI same-day edits Applies
Other payment indicators (8)

Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.

Compare payment localities

The national baseline uses GPCI 1.000. These locality-adjusted allowed amounts use each payment locality's own GPCIs. Select a state to see its localities.

Maine: $110.85–$115.07 across 2 localities ME Wisconsin: $111.40 WI Vermont: $114.34 VT New Hampshire: $119.31 NH Montana: $117.56 MT North Dakota: $114.40 ND Minnesota: $115.51 MN Michigan: $113.15–$119.18 across 2 localities MI New York: $113.04–$136.68 across 5 localities NY Massachusetts: $120.46–$130.58 across 2 localities MA Rhode Island: $119.95 RI Washington: $120.10–$132.61 across 2 localities WA Idaho: $110.05 ID Wyoming: $116.18 WY South Dakota: $114.02 SD Iowa: $109.35 IA Illinois: $115.47–$125.16 across 4 localities IL Indiana: $110.53 IN Ohio: $112.50 OH Pennsylvania: $112.46–$121.97 across 2 localities PA New Jersey: $125.64–$130.71 across 2 localities NJ Connecticut: $124.29 CT Oregon: $115.75–$123.58 across 2 localities OR Nevada: $116.74 NV Utah: $113.50 UT Colorado: $120.80 CO Nebraska: $109.72 NE Missouri: $109.32–$114.76 across 3 localities MO Kentucky: $110.59 KY West Virginia: $112.17 WV Virginia: $115.00 VA Maryland: $118.37–$123.98 across 2 localities MD Delaware: $116.59 DE California: $121.64–$146.95 across 29 localities CA Arizona: $114.98 AZ New Mexico: $113.77 NM Kansas: $109.28 KS Oklahoma: $110.09 OK Arkansas: $106.69 AR Tennessee: $109.75 TN North Carolina: $111.70 NC South Carolina: $112.30 SC District of Columbia: $131.52 DC Texas: $111.90–$120.48 across 8 localities TX Louisiana: $110.59–$114.83 across 2 localities LA Mississippi: $108.01 MS Alabama: $107.90 AL Georgia: $112.25–$119.75 across 2 localities GA Florida: $117.67–$128.15 across 3 localities FL Alaska: $145.71 AK Hawaii: $123.37 HI
$107–$113 $113–$120 $120–$126 $126–$133 $133–$139 $139–$146

Highest-paying locality

$146.95

CA flag San Jose-Sunnyvale-Santa Clara (San Benito County), Ca, CA

Lowest-paying locality

$106.69

AR flag Arkansas, AR

99203 non-facility rate by metro area

Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.

Anchorage, AK flag Anchorage, AK $145.71 Locality 02102-01 Washington, DC flag Washington, DC $131.52 Locality 12202-01 Northern New Jersey, NJ flag Northern New Jersey, NJ $130.71 Locality 12402-01 Hartford, CT flag Hartford, CT $124.29 Locality 13102-00 Honolulu, HI flag Honolulu, HI $123.37 Locality 01212-01 Denver, CO flag Denver, CO $120.80 Locality 04112-01 Providence, RI flag Providence, RI $119.95 Locality 14412-01
Show 24 more metros
Tampa, FL flag Tampa, FL $117.67 Locality 09102-99 Las Vegas, NV flag Las Vegas, NV $116.74 Locality 01312-00 Minneapolis, MN flag Minneapolis, MN $115.51 Locality 06202-00 Portland, ME flag Portland, ME $115.07 Locality 14112-03 Richmond, VA flag Richmond, VA $115.00 Locality 11302-00 Phoenix, AZ flag Phoenix, AZ $114.98 Locality 03102-00 San Antonio, TX flag San Antonio, TX $114.05 Locality 04412-99 Albuquerque, NM flag Albuquerque, NM $113.77 Locality 04212-05 Salt Lake City, UT flag Salt Lake City, UT $113.50 Locality 03502-09 Buffalo, NY flag Buffalo, NY $113.04 Locality 13282-99 Columbus, OH flag Columbus, OH $112.50 Locality 15202-00 Pittsburgh, PA flag Pittsburgh, PA $112.46 Locality 12502-99 Charleston, SC flag Charleston, SC $112.30 Locality 11202-01 Charlotte, NC flag Charlotte, NC $111.70 Locality 11502-00 Milwaukee, WI flag Milwaukee, WI $111.40 Locality 06302-00 Louisville, KY flag Louisville, KY $110.59 Locality 15102-00 Indianapolis, IN flag Indianapolis, IN $110.53 Locality 08102-00 Oklahoma City, OK flag Oklahoma City, OK $110.09 Locality 04312-00 Boise, ID flag Boise, ID $110.05 Locality 02202-00 Nashville, TN flag Nashville, TN $109.75 Locality 10312-35 Omaha, NE flag Omaha, NE $109.72 Locality 05402-00 Des Moines, IA flag Des Moines, IA $109.35 Locality 05102-00 Wichita, KS flag Wichita, KS $109.28 Locality 05202-00 Birmingham, AL flag Birmingham, AL $107.90 Locality 10112-00
Maine: $68.44–$69.39 across 2 localities ME Wisconsin: $67.25 WI Vermont: $68.71 VT New Hampshire: $71.33 NH Montana: $71.47 MT North Dakota: $68.30 ND Minnesota: $68.08 MN Michigan: $71.06–$74.70 across 2 localities MI New York: $69.26–$81.88 across 5 localities NY Massachusetts: $71.92–$75.54 across 2 localities MA Rhode Island: $72.33 RI Washington: $71.57–$76.05 across 2 localities WA Idaho: $67.65 ID Wyoming: $70.09 WY South Dakota: $67.93 SD Iowa: $67.18 IA Illinois: $73.38–$78.84 across 4 localities IL Indiana: $67.80 IN Ohio: $70.42 OH Pennsylvania: $70.14–$73.99 across 2 localities PA New Jersey: $75.30–$77.24 across 2 localities NJ Connecticut: $74.65 CT Oregon: $69.84–$72.37 across 2 localities OR Nevada: $70.60 NV Utah: $70.17 UT Colorado: $71.76 CO Nebraska: $67.18 NE Missouri: $69.59–$70.88 across 3 localities MO Kentucky: $69.61 KY West Virginia: $72.12 WV Virginia: $69.69 VA Maryland: $71.73–$74.53 across 2 localities MD Delaware: $71.05 DE California: $71.13–$80.49 across 29 localities CA Arizona: $70.31 AZ New Mexico: $71.50 NM Kansas: $67.61 KS Oklahoma: $68.93 OK Arkansas: $67.10 AR Tennessee: $67.85 TN North Carolina: $68.70 NC South Carolina: $69.71 SC District of Columbia: $77.23 DC Texas: $69.96–$73.83 across 8 localities TX Louisiana: $69.79–$71.46 across 2 localities LA Mississippi: $68.32 MS Alabama: $67.57 AL Georgia: $71.13–$72.92 across 2 localities GA Florida: $73.61–$80.17 across 3 localities FL Alaska: $96.62 AK Hawaii: $70.97 HI
$67–$72 $72–$77 $77–$82 $82–$87 $87–$92 $92–$97

Highest-paying locality

$96.62

AK flag Alaska, AK

Lowest-paying locality

$67.10

AR flag Arkansas, AR

99203 facility rate by metro area

Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.

Anchorage, AK flag Anchorage, AK $96.62 Locality 02102-01 Northern New Jersey, NJ flag Northern New Jersey, NJ $77.24 Locality 12402-01 Washington, DC flag Washington, DC $77.23 Locality 12202-01 Hartford, CT flag Hartford, CT $74.65 Locality 13102-00 Tampa, FL flag Tampa, FL $73.61 Locality 09102-99 Providence, RI flag Providence, RI $72.33 Locality 14412-01 Denver, CO flag Denver, CO $71.76 Locality 04112-01
Show 24 more metros
Albuquerque, NM flag Albuquerque, NM $71.50 Locality 04212-05 Honolulu, HI flag Honolulu, HI $70.97 Locality 01212-01 Las Vegas, NV flag Las Vegas, NV $70.60 Locality 01312-00 Columbus, OH flag Columbus, OH $70.42 Locality 15202-00 Phoenix, AZ flag Phoenix, AZ $70.31 Locality 03102-00 San Antonio, TX flag San Antonio, TX $70.31 Locality 04412-99 Salt Lake City, UT flag Salt Lake City, UT $70.17 Locality 03502-09 Pittsburgh, PA flag Pittsburgh, PA $70.14 Locality 12502-99 Charleston, SC flag Charleston, SC $69.71 Locality 11202-01 Richmond, VA flag Richmond, VA $69.69 Locality 11302-00 Louisville, KY flag Louisville, KY $69.61 Locality 15102-00 Portland, ME flag Portland, ME $69.39 Locality 14112-03 Buffalo, NY flag Buffalo, NY $69.26 Locality 13282-99 Oklahoma City, OK flag Oklahoma City, OK $68.93 Locality 04312-00 Charlotte, NC flag Charlotte, NC $68.70 Locality 11502-00 Minneapolis, MN flag Minneapolis, MN $68.08 Locality 06202-00 Nashville, TN flag Nashville, TN $67.85 Locality 10312-35 Indianapolis, IN flag Indianapolis, IN $67.80 Locality 08102-00 Boise, ID flag Boise, ID $67.65 Locality 02202-00 Wichita, KS flag Wichita, KS $67.61 Locality 05202-00 Birmingham, AL flag Birmingham, AL $67.57 Locality 10112-00 Milwaukee, WI flag Milwaukee, WI $67.25 Locality 06302-00 Des Moines, IA flag Des Moines, IA $67.18 Locality 05102-00 Omaha, NE flag Omaha, NE $67.18 Locality 05402-00

Look up your exact locality →

Q3 2026 amounts, computed with each locality's own GPCIs, before the ~2% sequestration cut. A state with more than one payment locality shows a range—its tile is colored by the mean across those localities, which is a shading choice, not an amount anyone is paid.

How this amount is computed Copy link

CPT 99203 has a work RVU of 1.60, a non-facility practice expense RVU of 1.76, a facility practice expense RVU of 0.38 and a malpractice RVU of 0.16—for total non-facility RVUs of 3.52 and total facility RVUs of 2.14 in the Q3 2026 release.

amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.

Release Q3 2026
Component RVU
Work RVU 1.60
Practice expense RVU (non-facility) 1.76
Practice expense RVU (facility) 0.38
Malpractice RVU 0.16

Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead—higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.

Payment review for 99203 Copy link

A useful payment check does not collapse patient status, visit level, and place of service into one decision. Price each reported line first, then investigate why the billed and expected contexts differ.

What to reconcile

  • Compare 99203 with 99204 under identical release, locality, and setting inputs.
  • Confirm that the contract’s Medicare basis is current-year or a named frozen year before applying its percentage.
  • Review same-day diagnostic lines against the NCCI release effective for the service period rather than today’s edit file.

Nearby payment lines

National Q3 2026 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.

Code Why compare Office Facility
99202 Lower new-patient payment line $75.15 $41.08
99204 Higher new-patient payment line $177.36 $116.90
G2211 Potential longitudinal-care add-on $17.37 $14.36
Check an actual payment Model this code in a contract

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS MLN: Evaluation and Management Services Guide; CMS National Correct Coding Initiative (NCCI) Edits.

Payment rules

Modifier amounts: -26/TC, -50, -80/81/82, -AS, -62, -66 Copy link

National non-facility amounts for the modifiers this code's indicators support. Single-line modifiers only. -51 (multiple-procedure reduction) depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one. Use the calculator for a locality-adjusted, sequestration-aware amount.

Modifier What it means Amount
-26/TC Professional/technical split Not payable
-50 Bilateral procedure Not payable
-80/81/82 Assistant surgeon (physician) (16%) $18.81 If documented
-AS Assistant at surgery (PA, NP, or CNS) (13.6%) $15.99 If documented
-62 Co-surgeons, each Not payable
-66 Team surgery Not payable

These apply standard MPFS percentages—assistant surgeon 16%, co-surgeon 62.5%, bilateral 150%—to the national non-facility amount above, and require both the RVU inputs and the applicable payment rule as evidence. They are derived here rather than read from a CMS column: check them against the current Medicare Claims Processing Manual before relying on them for payment. A row marked If documented carries the ordinary percentage, but this code's CMS indicator pays it only when supporting documentation of medical necessity is submitted—an unpaid claim without that documentation is not an underpayment.

Can you bill it with another code? Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 99203.

See every current NCCI pair for 99203 →

Billing together (NCCI edits) Copy link

NCCI Q3 2026

Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.

Not separately payable with 99203 on the same date of service—no modifier bypasses the edit (modifier indicator 0)

00100 99203 denies
00102 99203 denies
00103 99203 denies

Showing 3 of 384.

Separately payable with 99203 only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)

0362T 0362T denies
0373T 0373T denies
0395T 99203 denies

Showing 3 of 350.

Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.

Check a paired code or view all 734 NCCI pairs →

Billing G2211 with 99203 Copy link

Code-specific

G2211 is an add-on for a qualifying visit complexity, not a higher visit level. It recognizes the added work of being a continuing focal point for a patient's care, or providing ongoing care for a serious or complex condition—the relationship, not the diagnosis or visit length, is what qualifies.

Line Office Facility
99203 $117.57 $71.48
G2211 $17.37 $14.36
99203 + G2211 $134.94 $85.84

National amounts at GPCI 1.000, before sequestration. Use your locality.

  • Medicare generally denies G2211 when 99203 is reported with modifier 25 on the same date, for the same patient, by the same practitioner—whatever the reason the modifier is there.
  • A same-day clinical lab test does not by itself require modifier 25 on the visit, so it does not block G2211. Same-day minor procedures do require the modifier, and billing systems that auto-append modifier 25 for lab or point-of-care tests can strip G2211 payment unnecessarily. For dates of service on or after January 1, 2025, vaccine administration is an explicit exception; for 2024 dates of service, any modifier 25 on the base visit still blocks G2211.
  • For dates of service on or after January 1, 2025, a narrow exception applies when the same-day service is an annual wellness visit, a vaccine administration, or another listed Medicare Part B preventive service—the general modifier-25 denial does not apply in that case.
  • Ordinary Part B deductible and coinsurance apply to G2211—it is not a preventive service with waived cost sharing.

Sources: CMS FAQs about E/M visit complexity add-on HCPCS code G2211 and the CR 13705 allowed preventive-service list. The relationship and documentation requirements decide eligibility—this table only prices the combination once it applies. See the full G2211 guide for the relationship test, history, and the CY2027 proposal to convert G2211 into a percentage-based modifier.

Allowed amount, program payment, and patient share Copy link

These figures use the same national baseline, with different participation and payment assumptions.

Computed from the Q3 2026 CMS release

Medicare allowed amount

What Medicare recognizes as the full price for 99203 in the office (non-facility) setting. Every figure below derives from it.

$117.57
Medicare's share

80% of the allowed amount, before the ~2% sequestration cut.

$94.06
Patient coinsurance

The remaining 20%, once the annual Part B deductible is met. Medigap or Medicaid often covers it.

$23.51
Limiting charge

The ceiling a non-participating provider can bill a patient on an unassigned claim—109.25% of the allowed amount.

$128.44

National Q3 2026 figures at GPCI 1.000. Adjust for your locality and sequestration, or expand the explanations below for each figure in full.

Is $117.57 what a practice actually receives?

It's the national allowed amount—the starting point. Medicare pays 80% of it ($94.06) and the patient owes 20% coinsurance ($23.51). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. What lands is practice revenue: staff, space, equipment and billing, not clinician take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.

Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).

What's the non-participating amount for 99203?

$111.69 in the office (non-facility) setting—95% of the $117.57 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

What's the limiting charge for 99203?

$128.44 in the office (non-facility) setting—the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $117.57 amount above. The non-participating amount is 95% of the fee schedule rate ($111.69), and the statutory cap is 115% of that. See limiting charge.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

Common payment questions Copy link

Why would a Medicare claim for 99203 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

  • 384 codes form NCCI pairs with 99203 carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
  • 350 codes pair with 99203 under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together
  • Bilateral surgery: no bilateral adjustment. See billing policy
  • Assistant at surgery: restricted without documentation. See billing policy
  • Co-surgeons: not permitted. See billing policy
  • Team surgery: not permitted. See billing policy

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

History

Rate history by release Copy link

National non-facility amount for 99203 across quarterly releases. +48.4% increase since Q1 2013 · high $117.57 in Q1 2026

$118 $102 $86 $71 $55 Q1 2013 · $79.25 Q2 2014 · $108.18 (+36.5%) Q3 2014 · $108.18 (0.0%) Q4 2014 · $108.18 (0.0%) Q1 2015 · $109.05 (+0.8%) Q2 2015 · $109.05 (0.0%) Q3 2015 · $109.05 (0.0%) Q4 2015 · $109.60 (+0.5%) Q1 2016 · $108.85 (-0.7%) Q2 2016 · $108.85 (0.0%) Q3 2016 · $108.85 (0.0%) Q4 2016 · $108.85 (0.0%) Q1 2017 · $109.46 (+0.6%) Q2 2017 · $109.46 (0.0%) Q3 2017 · $109.46 (0.0%) Q4 2017 · $109.46 (0.0%) Q1 2018 · $109.80 (+0.3%) Q2 2018 · $109.80 (0.0%) Q3 2018 · $109.80 (0.0%) Q4 2018 · $109.80 (0.0%) Q1 2019 · $109.92 (+0.1%) Q2 2019 · $109.92 (0.0%) Q3 2019 · $109.92 (0.0%) Q4 2019 · $109.92 (0.0%) Q1 2020 · $109.35 (-0.5%) Q2 2020 · $109.35 (0.0%) Q3 2020 · $109.35 (0.0%) Q4 2020 · $109.35 (0.0%) Q1 2021 · $113.75 (+4.0%) Q2 2021 · $113.75 (0.0%) Q3 2021 · $113.75 (0.0%) Q4 2021 · $113.75 (0.0%) Q1 2022 · $113.85 (+0.1%) Q2 2022 · $113.85 (0.0%) Q3 2022 · $113.85 (0.0%) Q4 2022 · $113.85 (0.0%) Q1 2023 · $112.84 (-0.9%) Q2 2023 · $112.84 (0.0%) Q3 2023 · $112.84 (0.0%) Q4 2023 · $112.84 (0.0%) Q1 2024 · $109.69 (-2.8%) Q1 2024 · $111.51 (+1.7%) Q2 2024 · $111.51 (0.0%) Q3 2024 · $111.51 (0.0%) Q4 2024 · $111.51 (0.0%) Q1 2025 · $109.01 (-2.2%) Q2 2025 · $109.01 (0.0%) Q3 2025 · $109.01 (0.0%) Q4 2025 · $109.01 (0.0%) Q1 2026 · $117.57 (+7.9%) Q2 2026 · $117.57 (0.0%) Q3 2026 · $117.57 (0.0%) Q4 2026 · $117.57 (0.0%) Q1 2013 Q3 2016 Q2 2019 Q4 2021 Q2 2024 Q4 2026
Non-facility Facility
Release Status Non-facility Facility
Q4 2026 takes effect Oct 1, 2026 A $117.57 (0.0% no change ) $71.48 (0.0% no change )

Code and billing changes Copy link

The most relevant verified changes to this code and related Medicare billing policy.

Planned Full interactive timeline, two-date comparison, and an exportable citation packet.

Effective Jan 1, 2025

G2211 gained a limited modifier 25 exception

Medicare began allowing G2211 with a qualifying office/outpatient E/M base code, 99202-99205 or 99211-99215, with modifier 25 when an annual wellness visit, vaccine administration, or another CMS-listed eligible Part B preventive service is also furnished on the same date in the office or outpatient setting.

Effective Jan 1, 2021

The 30-44 minute time range took effect

When time is used instead of medical decision making to select 99203, the applicable total-time range is 30-44 minutes on the encounter date.

View all 5 changes, review scope, and source evidence

This price has been unchanged since Q1 2026, when it increased 7.9%.

When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

The 99203 rate last moved in Q1 2026. See its rate history.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

Beyond Medicare

Contracted rate: % of Medicare Copy link

Commercial payer contracts usually price off the Medicare amount above ("BCBS pays 115% of Medicare"). Enter your contract's percentage below to see what 99203 pays at that rate—$117.57 is 100%.

We want to build this: store your multipliers once, and every code page shows your rate instead of Medicare's. Tell us if you'd use it →

See how to find your contract's actual percentage.

Usage & related

How often 99203 is billed Copy link

Across Original Medicare in CY2024, 99203 ranked #22 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Beneficiaries
7.1M
Office + facility patients combined
Services
8.7M
Times it was billed
Allowed
$895.4M
Total Medicare allowed dollars
Compare: ↑ #21 more popular · 97530 ↓ #23 less popular · 99291

2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q3 2026 fee schedule above.

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q3 2026 release (effective July 2026). National baselines use GPCI 1.000 and exclude sequestration. Status and payment instructions determine whether a national amount is established; blank RVUs stay blank. Releases are immutable: historical evidence remains tied to the specified release. Modifier amounts apply standard MPFS percentages to this code's billing indicators. We derive them here rather than read them from CMS, so confirm them against the current Claims Processing Manual before relying on them for payment. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.

Physician relative value file (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 12,949)

Conversion factor $33.4009 read from the same file, row 11, column 26.

Use the (i) buttons next to each amount above for the exact row, columns, and math.

Cite this rate

This citation identifies the source release, so its evidence remains reproducible after a newer release lands.

CPT 99203 National PFS baseline: Office (non-facility) $117.57; Facility $71.48 (Q3 2026; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/99203/2026/C