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See a sample rate comparisonCPT 99212 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 O P Est Sf 10 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 10 Minutes Must Be Met Or Exceeded
| 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 99212 |
| Medicaid Fee Schedule | View Medicaid rates for 99212 |
National average reimbursement for CPT 99212 by major payers:
$56.23
$53.99
$51.48
$64.89
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CPT 99212
5 of 25 sample ratesHigher to lower in this preview
Benjamin Nulsen
$209.05Published rateJacquelyn Freeman
$68.07Published rateUsama Bin Tahir
New York City Health And Hospitals Corporation
$53.22Published rateGeorge Patton
$43.04Published rateBeverly Jones
Lakeland Regional Health Systems Inc
$23.39Published rate
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See a sample payer proposalCPT 99212 vs. Other Office or Other Outpatient Services Codes
The CPT 99212 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 99212 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 |
| 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. |
| 99212-CPT | Low | Office O P Est Sf 10 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 10 Minutes Must Be Met Or Exceeded |
| 99213-CPT | Low | Office O P Est Low 20 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of An Established 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 20 Minutes Must Be Met Or Exceeded |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99212. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99212 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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