CPT 99203 carries 1.60 work RVU under the CY 2026 Medicare Physician Fee Schedule (MPFS), and at the national non-facility conversion factor of $33.4009, the code produces an estimated Medicare payment of about $117.57 in the office setting and $71.48 in a facility setting. Those two numbers — work RVU and dollar payment — answer different questions, and the rest of this page keeps them separate rather than treating a “1.60” as if it were a price tag.
99203 is the CPT code for a new patient office or outpatient evaluation and management (E/M) visit at the low medical decision making (MDM) level, with a 30-minute time reference under the 2021 E/M framework CMS still uses for office visits. This page covers the RVU components behind the payment estimate, how conversion factor and geography change the final number, and where 99203 fits against neighboring E/M codes for productivity and contract analysis.
RVU Components Behind 99203
A CPT code’s Medicare payment is built from three separate RVU components, not a single number. Understanding which component is which matters because they respond to different variables — geography affects them differently, and only one of them (work RVU) typically drives physician compensation formulas.
| Component | What it represents | 99203 value (2026) |
|---|---|---|
| Work RVU | Physician time, skill, effort, and clinical risk involved in the visit | 1.60 |
| Practice Expense (PE) RVU, non-facility | Overhead cost of running the office where the visit occurs (staff, supplies, equipment) | 1.76 |
| Practice Expense (PE) RVU, facility | Reduced overhead RVU used when the visit happens in a hospital-owned or facility setting | 0.38 |
| Malpractice (MP) RVU | Cost of malpractice insurance associated with the service | 0.16 |
These figures come from the CY 2026 MPFS relative value file. The facility PE RVU is lower than the non-facility PE RVU because CMS assumes the hospital or facility — not the physician’s own office — is absorbing most of the overhead cost when the visit takes place there.
Adding the components gives total RVU, which is the figure that actually determines Medicare payment before geographic adjustment:
- Non-facility total RVU: 1.60 + 1.76 + 0.16 = 3.52
- Facility total RVU: 1.60 + 0.38 + 0.16 = 2.14
The work RVU stays identical in both settings. The entire 1.38-RVU gap between non-facility and facility total RVU comes from the PE RVU difference — this is why the same CPT code can generate two different Medicare payment amounts depending on where the visit happens.
From Total RVU to Medicare Payment
CMS does not pay a flat dollar amount per RVU. It multiplies total RVU by a conversion factor (CF), a dollar figure updated annually (and, starting in CY 2026, split into two separate rates for qualifying APM participants and non-qualifying practitioners). For CY 2026, CMS finalized:
- Qualifying APM conversion factor: $33.57
- Non-qualifying (non-QP) conversion factor: $33.4009 (published as $33.40)
Most physicians who are not part of a qualifying Alternative Payment Model bill under the non-QP conversion factor, so the examples below use $33.4009.
Simplified national formula (before locality adjustment):
Medicare Payment ≈ Total RVU × Conversion Factor
Applied to 99203:
- Non-facility: 3.52 × $33.4009 ≈ $117.57
- Facility: 2.14 × $33.4009 ≈ $71.48
This is a national estimate using a GPCI value of 1.0 across all three RVU components — it assumes no geographic adjustment at all. Actual Medicare payment for a specific claim almost never uses a flat GPCI of 1.0, because CMS applies a Geographic Practice Cost Index (GPCI) separately to the work, PE, and MP components based on the locality where the service is billed. A more complete formula looks like this:
Medicare Payment = [(Work RVU × Work GPCI) + (PE RVU × PE GPCI) + (MP RVU × MP GPCI)] × Conversion Factor
A practice billing 99203 in a high-cost locality (parts of California, New York, or Alaska, for example) will see a higher payment than the $117.57 national estimate, while a practice in a lower-cost rural locality will see less. Anyone comparing an actual remittance advice to a national RVU figure should expect a difference for exactly this reason — the GPCI calculator applies locality-specific indices to get a payment estimate that matches a specific ZIP code or Medicare Administrative Contractor (MAC) jurisdiction rather than the national average.
99203 Against Adjacent New Patient E/M Codes
99203 sits between the straightforward-level new patient visit (99202) and the moderate-complexity visit (99204). Comparing them side by side shows how quickly total RVU — and payment — scales with MDM complexity and time under the CY 2026 schedule:
| CPT | MDM Level | Work RVU | Non-Facility Total RVU | National Non-Facility Estimate (2026) |
|---|---|---|---|---|
| 99202 | Straightforward | 0.93 | 2.25 | ~$75.15 |
| 99203 | Low | 1.60 | 3.52 | ~$117.57 |
| 99204 | Moderate | 2.60 | 5.31 | ~$177.36 |
| 99205 | High | 3.50 | 7.09 | ~$236.81 |
A few patterns are worth calling out. The jump from 99202 to 99203 (0.67 additional work RVU) is smaller than the jump from 99203 to 99204 (1.00 additional work RVU), meaning the payment gap widens as MDM complexity increases rather than staying constant. This RVU comparison exists to help interpret payment and productivity impact — it is not a substitute for MDM documentation, time tracking, or payer-specific coding rules that determine which level actually applies to a given encounter. Selecting between 99203 and 99204 is a coding decision governed by 2021 E/M guidelines (MDM elements or total time), not an RVU decision.
For a deeper breakdown of the next level up, see the CPT 99204 RVU guide.
New Patient vs. Established Patient: Don’t Cross the Codes
99203 sometimes gets compared to 99213 or 99214 because all four codes are common office E/M visits, but 99203 is a new patient code while 99213 and 99214 are established patient codes — different CPT code families with different documentation requirements. A new patient, in CPT terms, is one who has not received any professional service from that physician or another physician of the same specialty in the same group within the past three years.
| CPT | Patient Type | Work RVU | Non-Facility Total RVU | Illustrative National Estimate |
|---|---|---|---|---|
| 99203 | New | 1.60 | 3.52 | ~$117.57 |
| 99213 | Established | 1.30 | ~2.85 | ~$95* |
| 99214 | Established | 1.92 | ~4.06 | ~$136* |
*Illustrative estimates calculated at the 2026 non-QP conversion factor of $33.4009; confirm exact PE and MP components against the current MPFS relative value file before using in a production report.
The work RVU values for 99213 (1.30) and 99214 (1.92) have carried over unchanged from CY 2025 into CY 2026 under CMS’s finalized schedule. The practical takeaway is that RVU totals only mean something once you know which code family and visit type you’re looking at — a higher total RVU on 99214 versus 99203 doesn’t imply that either code is more “valuable” to bill; it reflects that they describe different clinical situations entirely.
wRVU-Based Compensation Is Not the Same as Medicare Payment
This is where the two most commonly confused terms on this site diverge, and 99203 is a useful example. Medicare payment for 99203 uses total RVU (work + PE + MP), locality GPCI, and the conversion factor — the calculation covered above. Physician compensation, by contrast, typically uses only the work RVU component, multiplied by a negotiated dollar rate per wRVU that’s written into the employment or partnership contract.
Estimated wRVU Compensation = Credited Work RVU × Contract Rate per wRVU
Example (illustrative, not an official rate): if an employment agreement credits $55 per work RVU and a physician bills 99203 for a new patient visit, that single encounter contributes 1.60 wRVU × $55 = $88.00 toward productivity compensation — a figure that has no fixed relationship to the $117.57 national Medicare payment estimate for the same code. The compensation number depends entirely on the contract’s rate, not on what Medicare or any specific payer actually reimburses for the claim.
Several variables can make this gap wider or narrower in practice:
- Whether the employer freezes wRVU crediting to a specific CMS schedule year or updates annually.
- Whether modifiers, split/shared visits, or incident-to billing change which wRVU gets credited.
- Payer mix — commercial payers frequently use their own fee schedules, not the Medicare Physician Fee Schedule, so a practice’s actual blended revenue per 99203 will differ from the Medicare-only estimate above.
- Compensation thresholds, tiered rates, or quality withholds layered on top of the base wRVU rate.
Anyone modeling physician income from a batch of E/M visits should run wRVU-based compensation and Medicare payment as two separate calculations, using the salary calculator for the compensation side and the Medicare RVU calculator for the payment side, rather than assuming one number substitutes for the other.
Applying This to Productivity and Contract Review
For practice managers or compensation analysts reviewing a physician’s new-patient E/M mix, 99203 volume is a meaningful productivity signal only after a few conditions are confirmed:
- The employment contract actually credits 99203 toward the wRVU compensation formula (some contracts exclude certain visit types or cap new-patient credit).
- The contract specifies which CMS RVU schedule year applies — a contract frozen to an older schedule year could credit a different wRVU value than the current CY 2026 figure.
- Payer mix is accounted for separately, since Medicare’s RVU-based payment logic doesn’t apply to commercial contracts using percent-of-charge or capitated arrangements.
Contracts that are vague on any of these points are a common source of disputes over productivity bonus calculations — the contract red flags guide walks through the specific language to look for before signing or renegotiating a wRVU-based agreement.
Running the Numbers
The practical sequence for using 99203 RVU data is straightforward: confirm the current-year work RVU, PE RVU, and MP RVU components for the code; decide whether the analysis needs a non-facility or facility total RVU; apply the correct locality GPCI rather than the national average if the goal is an accurate payment estimate; and, if the underlying question is about physician income rather than Medicare reimbursement, switch to the work RVU and the contract’s dollar rate instead of the payment formula. Keeping the CPT code, setting, locality, schedule year, and QP/non-QP conversion factor status visible alongside any dollar figure prevents the single most common error in RVU reporting — treating a national, unadjusted estimate as if it were the actual amount a specific claim will pay.