What is CPT Code 99213?
CPT 99213 represents Office Visit — Moderate Complexity. It is one of the most frequently abused billing codes in hospital medicine. Upcoded to 99214 or 99215 for routine visits.
When This Code Appears on Your Bill
You may have this code on your bill if you received any of the following:
- Annual checkup
- Prescription renewal
- Single complaint visit
99213 becomes 99214/99215 when a doctor spends extra minutes documenting to justify higher billing. A visit under 20 minutes for a single issue should almost never be 99215.
CPT 99213 Rate Comparison
Rate benchmarks for CPT 99213
You have the right to request an itemized bill and compare every CPT code against published Medicare rates. If you find CPT 99213 billed above the Medicare rate without justification, you can formally dispute the charge. Hospitals must respond within 30 days.
Found CPT 99213 on your bill?
Our auditors check this code — and every other line item — against Medicare rates and billing guidelines. Most bills with CPT 99213 have additional errors too.
Related CPT Codes to Check
If CPT 99213 appears on your bill, also check these commonly paired or confused codes:
How to Dispute a CPT 99213 Overcharge
- Request your itemized bill from the hospital billing department
- Look up CPT 99213 on cms.gov/medicare/physician-fee-schedule
- Calculate the difference between what you were charged and Medicare rate
- Write a formal dispute letter citing CPT 99213 and the specific dollar discrepancy
- Send via certified mail to Patient Financial Services
- Follow up on day 20 if no response — escalate to Patient Advocate if needed