CPT 99213: office visit, established patient, level 3. What Medicare pays and what to ask
99213 is one of the most common codes in doctors' offices. Here is what it means and what the national Medicare rate is.
What this code means
CPT 99213 is an office or outpatient visit for a patient the practice has seen before, with low medical decision making or at least 20 minutes of total time on the date of the visit.
Vaccines, lab tests and procedures done during the same visit are billed on separate lines.
Why the bill can be much higher than the Medicare rate
If the office is owned by a hospital, you may also be charged a separate facility fee on top of the doctor's fee.
Insurance often pays a negotiated amount, so what you owe depends on your plan. The Medicare rate is a public reference point.
| If a line is billed at | It would be |
|---|---|
| 5x the Medicare rate | $475.95 |
| 10x the Medicare rate | $951.90 |
| 20x the Medicare rate | $1,903.80 |
The Medicare rate is a published benchmark, not a legal ceiling on what a provider may charge. Our free scan flags a line as worth a closer look when it is billed at more than 10 times the Medicare rate.
Questions worth asking before you pay
- Was I billed as an established patient, and does that match my history with the practice?
- Is there a facility fee on this bill, and why?
- Which services were added to the visit on separate lines?
Check every line against the official Medicare rates in about a minute. The scan is free.
Related codes
Source: Medicare Physician Fee Schedule (CMS, July 2026 release), national payment amount, non-facility setting. Last updated October 2026. This page is general information, not legal or medical advice. Rates change each year and a hospital bill can include charges that the benchmark does not cover.