CPT
90471 — Immunization administration, single vaccine
ACA-covered vaccines should be free, including the admin fee.
Office & outpatient evaluation
99213 — Office visit, established patient (15 min)
A standard office visit for a patient the provider has seen before. CPT 99213 is one of the most-billed codes in U.S. healthcare and one of the most-disputed.
- Typical setting: Doctor's office
- National avg charge (illustrative): Usually $80–$180 (insurance allowed amount); cash price varies.
- Most-disputed reason: Upcoded to 99214 or 99215 without supporting documentation.
What it means
What 99213 actually means
CPT 99213 is the second-from-lowest level of office visit for an established patient. It implies a low-to-moderate complexity problem and roughly 15 minutes of provider time. The most frequent dispute on this code is upcoding — the visit is billed as 99214 (the next level up) when the medical record only supports 99213.
If you were in and out of the room in 5–10 minutes for one focused issue, 99213 is the upper bound of what should be billed. Anything higher should have a documented reason in the chart.
Common errors with this code
What goes wrong on real bills.
Most bills that look correct still contain at least one of these issues. Up to 49% of medical bills contain errors (CFPB).
- Billed as 99214 or 99215 with no documented decision-making to support the upgrade.
- Charged twice for the same visit (one charge from the practice, one from a hospital outpatient department under a facility fee).
- Combined with a separate procedure code without the modifier 25 needed to indicate a significant, separately identifiable E/M service.
- Billed at out-of-network rates when the provider was actually in-network on the patient's plan.
If you see 99213 on your bill
Three steps before paying.
1. Get the itemized bill. If your statement only shows a summary, request the CPT-level itemized bill before paying. Generate the request language →
2. Cross-check against the EOB. Compare what your insurer's Explanation of Benefits says you owe versus what the hospital is asking. They disagree more often than people think. Read the bill-vs-EOB guide →
3. Run a free Bill Scan. Upload the bill (and EOB if you have it) and BillBusted will flag the most likely issues with this specific code in your specific state. Run free scan →
Related codes
Other codes in this category.
People who land on 99213 often also see these adjacent codes on the same bill.
CPT
90472 — Immunization admin; each additional vaccine
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90651 — Human papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90670 — Pneumococcal conjugate vaccine, 13 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90671 — Pneumococcal conjugate vaccine, 15 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90677 — Pneumococcal conjugate vaccine, 20 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
Related BillBusted guides
Plain-English reads if you see 99213 on a bill.
99213 FAQ
Plain-English answers.
How do I know if my 99213 was upcoded?
Pull the visit notes (you have a right to your medical record). Compare what was actually addressed to the level descriptors. If you see 99214 on the bill but the visit was a quick follow-up for one stable issue, that's a flag worth disputing.
What should 99213 cost?
Insurance allowed amounts typically run $80–$180 depending on region and payer. Cash-pay prices at non-hospital practices are often $100–$250. If you're being billed substantially more, request the itemized bill and run a free scan.
Can I dispute a 99213 charge?
Yes. The most successful disputes show that either (a) the visit didn't happen as billed, (b) the level was upcoded vs documentation, or (c) a duplicate charge appears under a different code. BillBusted's Resolution Pack drafts the dispute letter for your scenario.
Don't pay 99213 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.