Reimbursement
$23.05
Threshold
5m
2026 Status
Active
What is CPT Code 99211?
CPT 99211 is defined as: 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. Typically, 5 minutes are spent performing or supervising these services.
This code is primarily used for E/M services. It falls under the category of Evaluation and Management (E/M) - Office/Outpatient and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
0.18
Physician Effort
PE (Non-Fac)
0.5
Practice Expense
Malpractice
0.01
Risk Factor
Total RVU
0.69
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
virtual supervision
In 2026, the physician/QHP can provide 'direct supervision' via audio/video for 99211 nurse visits, enabling remote clinic models.
value protection
Exempt from efficiency adjustments because it is a low-intensity, time-based supportive service.
site neutrality
Facility and non-facility payments are balanced due to low indirect cost allocation.
Administrative Framework
Global Period
000
Place of Service
NCCI Exclusions
Key Modifiers
Operational Requirements
minimum time
Typically 5 minutes (recorded as clinical staff time)
staff type
Clinical staff (MA, LPN, RN) under direct supervision of Physician/QHP
frequency
As clinically necessary
add on codes
care plan requirement
Documentation of minimal presenting problem and clinical staff intervention.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Medicare focus on 'Integrated Care' makes 99211 a useful tool for frequent check-ins between major E/M visits.
Common Clinical Scenarios
CMS Eligibility: Minimal severity chronic or acute conditions. Brief assessment
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 99212
99212 requires Physician/QHP presence and higher MDM; 99211 is clinical staff only.
VS CCM
99211 is a face-to-face (or virtual equivalent) visit; CCM (99490) is monthly non-face-to-face management.
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