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CPT Code 99212 is used for established patient office or outpatient visits involving straightforward or low complexity. It is one of the lowest-level E/M codes available for face-to-face visits and typically applies to simple follow-up care.
What Is CPT Code 99212?
This code describes a short encounter, often related to a minor complaint, a single condition under control, or a routine service such as a medication check-in. The 2021 E/M guidelines allow it to be billed based on total time, which must be 10 to 19 minutes, or based on the level of medical decision-making.
When Should You Use 99212?
Use this code for visits involving limited or minimal issues. These might include reviewing a test result with no significant findings, confirming that a treatment plan is still appropriate, or managing a mild side effect.
While it is a low-paying code, using it appropriately can help reduce audit risk and support efficient care workflows. Avoid upcoding to higher levels unless truly supported by clinical data.
Documentation Tips
Keep records clear and concise. Indicate the condition managed, actions taken, and any education or counseling provided. If billing based on time, be sure to include total time spent.
Reimbursement for 99212 ranges between $45 and $65, depending on payer contracts.
FAQ: CPT Code 99212
How much time does 99212 cover?
Between 10 and 19 minutes of total time spent on the day of the visit.
Who can bill CPT 99212?
Physicians, nurse practitioners, and physician assistants can use this code.
What kind of conditions are appropriate for 99212?
Minor, self-limited issues or brief, low-risk follow-ups.
Can I use this for a new patient?
No, it is only for established patients.
