2025 CPT code 99212
(Revised) Effective Date: N/A Revision Date: N/A Evaluation and Management - Office or Other Outpatient Services Evaluation and Management Feed
Office or outpatient visit for an established patient with straightforward medical decision-making; total time on the encounter date must be 10 minutes or more.
Modifiers may apply depending on the circumstances of the visit (e.g., 25 for a significant, separately identifiable E/M service on the same day of another procedure).
The service must be medically necessary for the diagnosis or treatment of a patient's illness or injury.The documentation must support the medical necessity of the visit.
The physician performs a comprehensive assessment of the patient's condition, including history taking, physical examination (if necessary), and medical decision-making. The physician orders tests or treatments, explains the diagnosis and treatment plan to the patient, and coordinates care with other healthcare professionals as necessary.
In simple words: This code is for a doctor's visit for a returning patient with a simple health issue. The doctor spends at least 10 minutes with the patient, including time spent talking to the patient, examining them, and doing paperwork.
This CPT code represents an office or other outpatient visit for the evaluation and management of an established patient.The visit involves straightforward medical decision-making and/or the provider spends at least 10 minutes of total time on the encounter date. Total time includes face-to-face and non-face-to-face activities on the encounter date, such as reviewing tests, preparing for the visit, performing the exam, counseling the patient, ordering tests, communicating with other providers, documenting the encounter, interpreting results, and coordinating care.A medically appropriate history and/or examination may be performed, but the extent of these does not affect code selection.Documentation should reflect all services provided.
Example 1: A patient with a known history of hypertension presents for a routine follow-up visit.Blood pressure is checked, medications are reviewed, and the patient's overall health is assessed. The visit lasts 15 minutes., A patient presents with a minor respiratory infection. The physician performs a brief history and physical examination, prescribes medication, and offers advice on managing symptoms. The encounter lasts 12 minutes., An established patient presents for a routine physical examination and discussion regarding preventative measures. The visit includes counseling on diet and exercise and lasts 10 minutes.
Complete documentation should include the patient's chief complaint, history of present illness, past medical history, family history, social history, review of systems, physical examination findings (if performed), assessment, plan, and any counseling provided.Detailed documentation of time spent is crucial.Medical necessity should be clearly indicated.
** Always refer to the most current CPT codebook and payer guidelines for the most accurate coding and billing practices. The use of this code requires at least two of the three key components: problem-focused history, problem-focused examination, and straightforward medical decision-making.
- Revenue Code: Refer to payer-specific revenue codes.
- RVU: RVUs vary based on geographic location, facility type (non-facility vs. facility), and payer.
- Global Days: Not applicable.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedules will vary by payer and geographic location.Consult fee schedules from previous years for historical data.
- Specialties:Applicable across multiple medical specialties.
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center, other outpatient settings.