CPT 99215 Fee Schedule

Last Verified: November 2025

Healthcare providers use this code to document and receive reimbursement for visits that address high-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 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 40 Mintues Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024)

Key Fact	Detail
Service Type	• Evaluation and Management • Office or Other Outpatient Services
Common Place of Service	• 11 - Office • 22 - On Campus Outpatient Hospital • None
Common Modifiers	• None • 25 - Significant, separately identifiable E/M service same day • 95 - Telemedicine - audio and video
Complexity Level	High

National average reimbursement for CPT 99215 by major payers:

$173.73

$171.95

$165.55

$242.09

Preview provider-level rates for...

For billing codeCPT 99215

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 99215
United	99215	$185.86	1780020404 - ELLIOT BIGAJER	111631746 - BROOKDALE HOSPITAL MEDICAL CENTER	NY	Gastroenterology Physician (207RG0100X)
United	99215	$260.23	1548839137 - SANDY SOLIMAN	352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER	TN	Physician Assistant (363A00000X)
United	99215	$360.67	1184625428 - MARK GILCHRIST	274317046 - (MA) MARK G. GILCHRIST, M.D., LLC	MA	Pediatrics Physician (208000000X)
United	99215	$374.29	1104320068 - FRANK GONZALEZ	953777340 - CHILDRENS HOSPITAL LOS ANGELES MEDICAL GROUP INC	CA	Pediatrics Physician (208000000X)
United	99215	$205.60	1962801605 - MICHELLE SANCHEZ	770460802	CA	Obstetrics & Gynecology Physician (207V00000X)
United	99215	$206.39	1780807545 - BRIDGET LOPARO	204881619 - UNIVERSITY HOSPITALS HEALTH SYSTEM INC	MA	Pediatrics Physician (208000000X)
United	99215	$390.98	1568826493 - SUSAN DAVIS	581537752 - EMORY UNIVERSITY	GA	Obstetrics & Gynecology Physician (207V00000X)
United	99215	$222.92	1316975295 - KINA PEPPERS	362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION	IL	Obstetrics & Gynecology Physician (207V00000X)
United	99215	$446.54	1417275116 - MARJORIE BHOGAL	941156581 - SUTTER BAY MEDICAL FOUNDATION	CA	Obstetrics & Gynecology Physician (207V00000X)
United	99215	$85.00	1295777605 - EAST COAST INFERTILITY AND IVF P C, DBA DAMIEN FERTILITY PARTNERS	223221484	NJ	Specialist (174400000X)
United	99215	$260.32	1063515153 - PHILIP LAHRMANN	60646668 - HARTFORD HOSPITAL	CT	Obstetrics & Gynecology Physician (207V00000X)
United	99215	$395.70	1609192749 - SVETLANA KACHAN-LIU	222560501 - (MA) MASS GENERAL BRIGHAM INCORPORATED	MA	Pediatrics Physician (208000000X)
United	99215	$357.54	1154749794 - RACHEL SULLIVAN	352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER	TN	Pediatric Cardiology Physician (2080P0202X)
United	99215	$302.85	1699009217 - ERIN LEGRAND	272006180	OR	Obstetrics & Gynecology Physician (207V00000X)
United	99215	$429.20	1144574955 - DIANE BELDER-PRESTON	42807148 - MASS GENERAL BRIGHAM INCORPORATED	MA	Pediatrics Physician (208000000X)
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 99215 vs. Other Office or Other Outpatient Services Codes

The CPT 99215 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 99215 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
99213	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 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. (Desc Rvsd 1/1/2024)
99214	Moderate	Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And/Or Examination And Moderate Level Of Medical Decisionmaking. 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)
99215	High	Office Or Other Outpatient Visit For The Evaluation And Management Of An Established 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 40 Mintues 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 99215. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99215 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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