CPT Code 99213
Established Patient Office Visit (Level 3)
Simple English Explanation
A 20-29 minute visit for an existing patient with low complexity needs.
Why doctors use this: The most common code for a standard doctor's appointment (e.g., medication refill, basic sickness).
Typical US Price Range
$70 – $150*Estimated cash price before insurance adjustments.
Why prices vary: The cost can change drastically depending on whether you are at a hospital ER (most expensive), a hospital outpatient department, or a private doctor's office. Your location and specific insurance plan also play a huge role.
Questions to Ask Billing
- "Can you confirm if CPT 99213 was billed as a screening or diagnostic test?"
- "Is there a discount for paying this code in cash immediately?"
- "Does this charge include the doctor's fee, or will I get a separate bill for that?"
Frequently Asked Questions
Is CPT 99213 covered by insurance?
Most standard insurance plans cover Established Patient Office Visit (Level 3) when deemed medically necessary. However, you may still owe a copay or coinsurance depending on your specific plan's deductible status.
What if I was charged more than $150?
If your bill is significantly higher than the typical range, you can call the billing department and ask for an explanation. You can also compare the price to the "Medicare Allowable" rate for your area to see if the charge is excessive.
Disclaimer: This website provides educational information only and does not provide medical, legal, or insurance advice. CPT® is a registered trademark of the American Medical Association. Prices are estimates based on national averages.