CPT 99211 Fee Schedule

Q: What factors affect fee schedules?

Factors that affect fee schedules include 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), and Provider Type (hospital providers may have different rates than private practice).

Last Verified: February 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

National average reimbursement for CPT 99211 by major payers:

$25.54

$26.03

$24.39

$34.00

Preview provider-level rates for...

For billing codeCPT 99211

Payer	Code	Rate	NPI	Tax ID	State	Specialty
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99211
United	99211	$36.97	1184004301 - PALASHKUMAR JAISWAL	371521145 - (TX) WICHITA FALLS GASTROENTEROLOGY ASSOCIATES	TX	Gastroenterology Physician (207RG0100X)
United	99211	$62.51	1568966844 - RAJESH KULENTHIRARAJAN	43066227 - HYDE PARK PEDIATRICS PC	MA	Pediatrics Physician (208000000X)
United	99211	$28.89	1124029491 - PHILIPPE EDOUARD	680437840 - PETALUMA HEALTH CENTER	CA	Internal Medicine Physician (207R00000X)
United	99211	$23.45	1528086287 - ROBERT NEWBURY	271376321 - PRIMA MEDICAL FOUNDATION	CA	Critical Care Medicine (Internal Medicine) Physician (207RC0200X)
United	99211	$36.41	1679935100 - KHAYRI SHALHOUB	260834681 - TEXAS CHILDRENS PHYSICIAN GROUP	MA	Pediatrics Physician (208000000X)
United	99211	$17.44	1912913542 - STEPHEN BHARUCHA	133626443 - (NY) MICHAEL A ANTONY MD PC	NY	Gastroenterology Physician (207RG0100X)
United	99211	$16.43	1598717704 - STEVEN TAWIL	112572969 - (NY) SHAPIRO, GOLDMAN & TAWIL, M.D., P.C	NY	Gastroenterology Physician (207RG0100X)
United	99211	$24.97	1720425234 - KEVIN SMITH	371424390 - ELICA HEALTH CENTERS	CA	Internal Medicine Physician (207R00000X)
United	99211	$62.51	1093030090 - CAROLYN WALSH	43066227 - HYDE PARK PEDIATRICS PC	MA	Pediatrics Physician (208000000X)
United	99211	$54.95	1487815551 - DANIEL FREEDBERG	135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK	NY	Gastroenterology Physician (207RG0100X)
United	99211	$18.20	1205254331 - DAVID HERMAN	953567895 - LOS ANGELES LGBT CENTER	CA	Internal Medicine Physician (207R00000X)
United	99211	$49.78	1770562324 - RICHARD MARSHALL	320058309 - ASSOCIATED PHYSICIANS OF HARVARD FACULTY PHYSICIANS AT BETH ISREAL	MA	Pediatrics Physician (208000000X)
United	99211	$53.04	1568877413 - SUPAKANYA WONGRAKPANICH	330672915 - FACULTY PHYSICIANS AND SURGEONS OF LLUSM	CA	Internal Medicine Physician (207R00000X)
United	99211	$30.44	1821179391 - BRIAN LIPSON	815450499 - ALLERGY & ASTHMA CONSULTANTS, PC	CA	Allergy & Immunology (Internal Medicine) Physician (207RA0201X)
United	99211	$35.88	1720141864 - DANIEL BERGERON	461177336 - ST PETERS HEALTH PARTNERS MEDICAL ASSOCIATES PC	NY	Internal Medicine Physician (207R00000X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

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CPT 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 Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand 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. (Desc Rvsd 1/1/2024)
99204-CPT	Moderate	Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand 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. (Desc Rvsd 1/1/2024)
99205-CPT	High	Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand 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. (Desc Rvsd 1/1/2024)
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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