Reimbursement
$179.36
Threshold
40m
2026 Status
Active
What is CPT Code 99215?
CPT 99215 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 high level of medical decision making. When using time for code selection, 40-54 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
2.8
Physician Effort
PE (Non-Fac)
2.38
Practice Expense
Malpractice
0.19
Risk Factor
Total RVU
5.37
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).
valuation tier
Third highest outpatient E/M payment ($171.01) after 99205 and 99204.
Administrative Framework
Place of Service
Key Modifiers
Operational Requirements
selection criteria
High MDM OR 40-54 minutes total time.
patient status
Established patient.
frequency
Once per encounter.
Compliance Checklist
Audit Defense
mdm high
Documentation must specify 'High risk of morbidity' or 'High complexity of data reviewed'.
2026 Update
G2212 (Prolonged service) can be added for 99215 only if total time exceeds 54 minutes.
Common Clinical Scenarios
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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