Reimbursement
$57.45
Threshold
10m
2026 Status
Active
What is CPT Code 99212?
CPT 99212 is defined as: 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 time for code selection, 10-19 minutes of total time is spent on the date of the encounter.
This code is primarily used for E/M services. It falls under the category of Evaluation & Management 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
0.7
Physician Effort
PE (Non-Fac)
0.98
Practice Expense
Malpractice
0.04
Risk Factor
Total RVU
1.72
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency shield
Protected from the -2.5% productivity adjustment (E/M service).
g2211 compatibility
Eligible for G2211 if the visit represents longitudinal management of a chronic condition.
Administrative Framework
Place of Service
Key Modifiers
Operational Requirements
selection criteria
Straightforward MDM OR 10-19 minutes total time.
patient status
Established patient (has seen the provider or group within 3 years).
frequency
Once per encounter.
Compliance Checklist
Audit Defense
documentation sufficiency
Even for 'Straightforward' levels, the record must justify that the provider's presence was medically necessary.
2026 Update
2026 reimbursement for 99212 remains focused on supporting low-acuity maintenance care.
Common Clinical Scenarios
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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