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What Is CPT Code 99211?

 CPT code 99211 is a minimal-level evaluation and management (E/M) service for an established patient in an office or outpatient setting. Often called a “nurse visit,” it typically involves simple clinical assessments that don’t require a physician’s direct presence. The presenting problems are minimal, and the encounter usually lasts about five minutes.

What Are the Criteria for Billing CPT Code 99211?

To properly bill CPT 99211, the encounter must meet the following conditions:

  • Established patient: The patient must have been seen previously by the provider or group.
  • Face-to-face encounter: The visit must be in person — not by phone, email, or portal.
  • Evaluation and management (E/M) component: The nurse or qualified staff must perform a brief history, assessment, or management activity. Purely administrative tasks don’t qualify.
  • Separately identifiable service: The service must be distinct from other E/M services on the same day.
  • Medical necessity: Documentation must show a medically necessary reason for the visit.

When Can CPT Code 99211 Be Billed?

Common examples of appropriate use include:

  • Blood pressure checks for medication follow-up.
  • Suture or staple removal from another facility’s procedure.
  • Simple wound care or dressing change.
  • Medication management and counseling by nursing staff.
  • UTI workup coordinated with a supervising clinician.
  • Routine injections (e.g., methotrexate) with vitals check.
  • Reviewing lab results and adjusting medication under physician guidance.

What Services Should Not Be Billed with CPT Code 99211?

When billed under Medicare, CPT 99211 must meet incident-to requirements:

  • The service must be incidental to a physician or qualified healthcare professional’s care plan.
  • The QHP must initiate the treatment course.
  • Direct supervision is required — the QHP must be in the office suite (though not the same room) when the service occurs.

What Are the Medicare “Incident-To” Billing Requirements for 99211?

When billed under Medicare, CPT 99211 must meet incident-to requirements:

  • The service must be incidental to a physician or qualified healthcare professional’s care plan.
  • The QHP must initiate the treatment course.
  • Direct supervision is required — the QHP must be in the office suite (though not the same room) when the service occurs.

What Are the 2025 Changes for CPT Code 99211?

Recent CMS updates for 2025 include:

  • Virtual supervision: Direct supervision may now be performed via real-time audio-video technology.
  • Add-on code G2211: May be reported with 99211 when performed by the same practitioner on the same day as a qualifying preventive service (e.g., wellness visit or vaccination).

Is cpt code 99211 still valid?

Yes, CPT code 99211 is still valid and in use for 2025. It is used for medical billing to describe a low-level evaluation and management (E/M) service for an established patient.

Have the Criteria for Using CPT Code 99211 Changed Over Time?

Yes. While CPT code 99211 remains valid, the criteria for its use have evolved to ensure proper documentation and alignment with other E/M codes. Below are the key updates and clarifications:

  • Minimal problem wording removed: The descriptor for 99211 originally included the phrase “Usually, the presenting problem(s) are minimal”. This was removed in 2022 to prevent confusion and better align the code with other E/M codes.
  • Time no longer a factor: As of 2021, you cannot bill for CPT code 99211 based solely on time. Unlike other office visit codes, the documentation of time does not determine the code level, although clinical staff can still record the time spent.
  • Use by clinical staff: The code is most often used for services rendered by a member of the clinical staff, such as a nurse or medical assistant, under the direct supervision of a physician. While a physician can bill for 99211, experts note that documentation for a direct physician encounter would likely justify a higher-paying code, such as 99212.
  • “Incident-to” requirements: For Medicare and other payers, 99211 is typically billed as an “incident-to” service, which has specific requirements. For example, the supervising physician must be present in the office suite, and the service must be part of an ongoing care plan.
  • Not for all minor services: Code 99211 is for an E/M service and is not appropriate if another, more specific CPT code exists for the service. For instance, you should bill for an immunization with an injection code, not 99211.

What Is the Average Reimbursement for CPT Code 99211?

In 2025, the national average for CPT code 99211 is approximately $22 to $28, but the exact reimbursement amount varies depending on the payer and the location of the service. It is generally the lowest-paying evaluation and management (E/M) code.

Reimbursement by payer:

  • Medicare: As of 2025, the national average payment is $22.64 for a non-facility setting. This amount is tied to the lower Medicare Physician Fee Schedule (PFS) conversion factor for 2025, which saw a decrease from the previous year.
  • Commercial insurance: These rates are often higher, averaging between $25 and $40 in 2025. Rates are negotiated as part of specific contracts between providers and commercial payers, with some regions offering higher payments.
  • Medicaid: Reimbursement for Medicaid is typically lower than Medicare, with a rate of $17.21 listed for 2025 in some sources.
  • Facility vs. non-facility fees: The reimbursement rate also differs based on where the service is performed. For example, Medicare’s 2025 national rate is $22.64 for a non-facility (office) setting but only $8.41 for a facility setting.

What Services Should Not Be Billed with CPT Code 99211?

Services that should NOT be billed with CPT code 99211 include:

  • Routine medication administration (e.g., injections or infusions) without additional evaluation or management.

  • Simple blood pressure checks that do not lead to management decisions.

  • Drawing blood for labs or diagnostic tests (venipuncture should be billed separately).

  • Faxing medical records or non-clinical administrative tasks.

  • Telephone calls to report results or reschedule procedures without a clinical visit.

  • Performing diagnostic or therapeutic procedures where another code exists or the service is bundled.

  • Recording lab results in the medical record without clinical interaction.

  • Reporting vaccines alone unless part of a broader E/M service.

  • Writing new or refill prescriptions when no evaluation or management is performed.

The key to billing 99211 appropriately is that the service must include a medically necessary evaluation and management component—such as patient education, simple clinical examination, or management decisions—even if the physician is not present. Documentation must demonstrate this clinical interaction and supervision.

Billing 99211 purely for administrative or routine tasks without documented medical necessity is not compliant and will result in claim denials on review.

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