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See a sample rate comparisonCPT 99211 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient, That May Not Require The Presence Of A Physician Or Other Qualified Health Care Professional. Usually, The Presenting Problem(S) Are Minimal.
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Office or Other Outpatient Services |
| Common Place of Service | 11 - Office None |
| Common Modifiers | None 25 - Significant, separately identifiable E/M service same day 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99211 |
| Medicaid Fee Schedule | View Medicaid rates for 99211 |
National average reimbursement for CPT 99211 by major payers:
$25.54
$26.03
$24.39
$32.39
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CPT 99211
5 of 25 sample ratesHigher to lower in this preview
Rajesh Kulenthirarajan
Hyde Park Pediatrics PC
$62.51Published rateCarol Ilzarbe
Harvard Medical Faculty Phys At Beth Israel Deaconess Med Ctr Inc
$49.78Published rateBrian Lipson
Allergy & Asthma Consultants, PC
$30.44Published rateKevin Smith
Elica Health Centers
$24.97Published rateSteven Tawil
Shapiro, Goldman & Tawil, M.D., P.C
$16.43Published rate
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See a sample payer proposalCPT 99211 vs. Other Office or Other Outpatient Services Codes
The CPT 99211 code is part of the Evaluation and Management services used for Office or Other Outpatient Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99211 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99203-CPT | Low | Office O P New Low 30 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And Or Examination And Low Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 30 Minutes Must Be Met Or Exceeded |
| 99204-CPT | Moderate | Office O P New Mod 45 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And Or Examination And Moderate Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 45 Minutes Must Be Met Or Exceeded |
| 99205-CPT | High | Office O P New Hi 60 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And Or Examination And High Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 60 Minutes Must Be Met Or Exceeded |
| 99211-CPT | Low | Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient, That May Not Require The Presence Of A Physician Or Other Qualified Health Care Professional. Usually, The Presenting Problem(S) Are Minimal. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99211. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99211 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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