99212 CPT Code a Simple Complete Guide for Medical Billing

CPT code 99212 is assigned for an office or outpatient visit with an established patient that includes a problem-focused evaluation and management (E/M) service. This code typically reflects a low level of complexity, where the physician spends about 10–19 minutes face-to-face with the patient.

You should use CPT 99212 when the visit involves a straightforward medical issue, requiring limited data review or decision-making. If the condition is more complex and the provider must evaluate multiple systems or make moderate-level decisions, CPT 99213 would be more appropriate.

To maintenance billing for 99212, documentation should include:

• A brief history of the problem (chief complaint)
• A problem-focused examination
• Straightforward medical decision-making
  Alternatively, if using time-based coding, document the total time spent (10–19 minutes) and ensure it was primarily spent on counseling or coordination of care.

As of 2025, the Medicare reimbursement for CPT 99212 typically ranges between $46 to $53, but rates may vary based on location, payer contract, and modifiers. Check with your local MAC or private payer for the exact fee schedule.

Yes, under the 2021 E/M guidelines, CPT code 99212 can be selected based on total time spent on the encounter, including:

• Reviewing records
• Seeing the patient
• Ordering tests
• Documenting in the EHR
  the complete time an important be 10–19 minutes on the date of the visit.

CPT code 99212 is eligible for telehealth billing when all necessary documentation and time-based requirements are properly met. Make sure to append the appropriate telehealth modifier (like 95 or GT) and confirm the payer’s telemedicine policy.