How Much Does CPT Code 99213 Cost?

TL;DR:
CPT code 99213 is used for a standard, established patient office visit.
Typical out-of-pocket costs range from $90 to $250, depending on your provider, insurance, and location.

🩺 What is CPT Code 99213?

• CPT Code: 99213
• Description: Office or other outpatient visit for the evaluation and management of an established patient.
• Complexity Level: Low to moderate (15-29 minutes face-to-face with the patient).
• Typical Use: Routine check-ups, follow-up visits, minor acute issues (cold, rash, blood pressure follow-up).

💵 How Much Does CPT Code 99213 Cost?

🔎 Pro Tip: Prices can vary wildly based on geography and clinic type.
An independent physician might charge $120, while a hospital-owned clinic could bill $250+ for the exact same service.

🏥 Why Does CPT 99213 Cost So Much at Hospitals?

• Facility Fees: Hospitals often tack on extra fees just for being a hospital.
• Administrative Overhead: More staff, more paperwork, more cost.
• Insurance Negotiations: Large systems negotiate different rates than independent practices.

If you’re paying out-of-pocket, call ahead and ask for a self-pay discount.
Many clinics will offer 20-40% off cash prices.

📊 Real Example: My Own CPT 99213 Bill

I once got slapped with a $220 bill for a simple blood pressure follow-up.
Here’s the breakdown:

Had I known to ask for a cash pay rate, it would’ve been $95 flat.

🤔 When Should You Expect CPT 99213?

You’ll likely see CPT 99213 on your bill for:

• Follow-up appointments (chronic conditions, check-ups)
• Minor acute issues (cold, skin rash, mild infections)
• Medication management visits
• Basic mental health follow-ups (non-psychotherapy)

If your visit feels routine and doesn’t involve complex diagnostics, this is the code they’ll slap on your bill.

🔍 CPT 99213 vs. 99214: What’s the Difference?

🧰 Helpful Tools

• ✅ Use Our CPT Code Cost Checker Tool