CPT 99213
CPT Code 99213: Office visit, established patient, low complexity
Duration
20-29 min
Typical Fee
$85-$160
Type
Outpatient therapy
Note: Most common follow-up E/M.
When to Use CPT 99213
Use CPT code 99213 when billing for office visit, established patient, low complexity. This code is used by licensed therapists (LCSW, LPC, MFT, Psychologist) for outpatient sessions.
Adding CPT 99213 to a Superbill
When generating a superbill with CPT 99213, include the ICD-10 diagnosis code, date of service, fee charged, amount paid, and your NPI number. Superbilled pre-fills common therapy CPT codes automatically.
Common ICD-10 Pairings
These diagnosis codes are frequently used alongside CPT 99213:
Documentation Requirements
Document low-complexity medical decision making with at least two data points reviewed. Include medication management notes if applicable.
Common Denial Reasons
- ✗ Complexity documented warrants upcoding to 99214 or downcoding to 99212
- ✗ Insufficient documentation of data reviewed or assessed
- ✗ Missing follow-up plan or treatment adjustments
Reimbursement Expectations
OON reimbursement typically 50-70% of UCR. Expect $43-$112 from commercial insurers.