CPT 99212 Fee Schedule
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.
| 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 | Moderate |
National average reimbursement for CPT 99212 by major payers:
$56.23
$53.99
$51.48
$75.38
| 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 99212 | ||||||
United | 99212 | $105.73 | 1639141054 - FREDERIC WIEN | 264709927 - WESTCHESTER MEDICAL CENTER ADVANCED PHYSICIAN SERVICES, P.C | NY | Gastroenterology Physician (207RG0100X) |
United | 99212 | $32.93 | 1881949543 - AMRITA ROY | 160743209 - UNIVERSITY OF ROCHESTER | NY | Obstetrics & Gynecology Physician (207V00000X) |
United | 99212 | $50.25 | 1023064284 - RENEE STEIN | 460847235 | MO | Obstetrics & Gynecology Physician (207V00000X) |
United | 99212 | $43.86 | 1588716492 - MARLON ILAGAN | 592358293 - (FL) GASTROENTEROLOGY ASSOCIATES OF CENTRAL FLORIDA, P.A. | FL | Gastroenterology Physician (207RG0100X) |
United | 99212 | $25.68 | 1750375416 - JOSEPH ABOUJAOUDE | 263024603 - (NY) JOSEPH ABOUJAOUDE, M.D., PLLC | NY | Gastroenterology Physician (207RG0100X) |
United | 99212 | $80.93 | 1356871917 - GABRIELLA PUGLIESE | 223693606 - REGIONAL WOMEN'S HEALTH GROUP, LLC | PA | Obstetrics & Gynecology Physician (207V00000X) |
United | 99212 | $73.58 | 1174735054 - MARY EACCARINO | 582422542 - ATLANTA WOMENS HEALTH GROUP, P.C. | GA | Obstetrics & Gynecology Physician (207V00000X) |
United | 99212 | $59.09 | 1962696088 - RICARDO PRIETO | 923479126 | FL | Gastroenterology Physician (207RG0100X) |
United | 99212 | $41.88 | 1649513144 - KONSTANTIN PEYSIN | 474035304 - (NY) TRIBOROUGH GI PLLC | NY | Gastroenterology Physician (207RG0100X) |
United | 99212 | $83.51 | 1437136678 - MICHAEL KEELEY | 562120710 | NC | Obstetrics & Gynecology Physician (207V00000X) |
United | 99212 | $35.88 | 1417959073 - PETER YOTSEFF | 650963459 - (FL) GASTROINTESTINAL DIAGNOSTIC CENTERS | FL | Gastroenterology Physician (207RG0100X) |
United | 99212 | $33.00 | 1790917870 - ALBIN ABRAHAM | 264073395 - (NC) GRANVILLE HEALTH INC | IN | Gastroenterology Physician (207RG0100X) |
United | 99212 | $209.05 | 1467795377 - BENJAMIN NULSEN | 954373071 | NY | Gastroenterology Physician (207RG0100X) |
United | 99212 | $84.44 | 1104818871 - SUSQUEHANNA OB-GYN LLC | 202265068 - INTERNAL MEDICINE ASSOCIATES OF RESTON | MD | Obstetrics & Gynecology Physician (207V00000X) |
United | 99212 | $53.11 | 1316331267 - SAGARIKA SATYAVADA | 920192097 | TX | Gastroenterology Physician (207RG0100X) |
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 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 |
|---|---|---|
| 99202 | Low | Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand Straightforward Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 15 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024) |
| 99203 | 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 | 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) |
| 99212 | Low | 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. (Desc Rvsd 1/1/2024) |
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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