99203
Office/outpatient visit, new patient, low-mod complexity
Office/outpatient visit, new patient, low-mod complexity is the #61 most-billed Medicaid procedure code, with $3.23B in payments across 47.8M claims from 2018–2024. The national median cost per claim is $57.85.
Total Paid
$3.23B
0.29% of all spending
Total Claims
47.8M
Providers
48K
Avg Cost/Claim
$68
National Cost Distribution
How much do providers bill per claim for 99203? Based on 45K providers billing this code nationally.
Median
$57.85
Average
$62.54
Std Dev
$39.74
Max
$955.06
Percentile Distribution (Cost per Claim)
50% of providers bill between $42.01 and $78.08 per claim for this code.
90% bill between $22.89 and $98.32.
Top 1% bill above $215.59.
About This Procedure
HCPCS code 99203 (Office/outpatient visit, new patient, low-mod complexity) was billed by 48K providers across 47.8M claims, totaling $3.23B in Medicaid payments from 2018–2024. This code was used for 44.4M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$57.85
Providers Billing
45K
National Spending
$3.23B
Avg/Median Ratio
1.08×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 99203
| # | Provider | Total Paid |
|---|---|---|
| 1 | City Medical Of Upper East Side Pllc New York, NY · Clinic/Center Urgent Care | $66.7M |
| 2 | Nextcare Arizona Llc Tempe, AZ · Clinic/Center, Urgent Care | $29.7M |
| 3 | 1609229764 | $25.8M |
| 4 | 1376598326 | $18.6M |
| 5 | 1871998963 | $17.0M |
| 6 | North Shore Lij Urgent Care P.c. Rockville Centre, NY · Clinic/Center Urgent Care | $16.6M |
| 7 | 1073565610 | $14.5M |
| 8 | 1669825162 | $11.7M |
| 9 | Planned Parenthood/orange And San Bernardino Counties, Inc. Orange, CA · Clinic/Center, Ambulatory Family Planning Facility | $10.9M |
| 10 | Montefiore Medical Center Bronx, NY · Anesthesiology | $10.4M |
| 11 | 1659425825 | $10.1M |
| 12 | 1205105004 | $9.4M |
| 13 | 1215903018 | $9.2M |
| 14 | 1235411547 | $9.0M |
| 15 | 1225331903 | $8.9M |
| 16 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $8.9M |
| 17 | 1134349954 | $8.6M |
| 18 | 1215219878 | $8.5M |
| 19 | 1407974579 | $8.3M |
| 20 | New York Network Ipa Inc Brooklyn, NY · Exclusive Provider Organization | $8.2M |
Showing top 20 of 48K providers billing this code