February 21, 2025
Medical billing can be confusing, especially when dealing with Evaluation and Management (E/M) codes. If you’re looking for clear and simple information about the 99212 CPT codes, this guide will help you understand its definition, usage, and reimbursement rates for 2025.
CPT Code 99212 is an Evaluation and Management (E/M) code used for office visits with established patients. It applies when a provider spends at least 10 minutes face-to-face with the patient and meets at least two of the following three components:
This code is typically used for minor health concerns that require limited medical decision-making.
E/M codes range from 99202 to 99205 (for new patients) and 99211 to 99215 (for established patients). The difference between them depends on the complexity of the visit and time spent:
Reimbursement rates for 99212 CPT codes can vary depending on the payer (Medicare, Medicaid, or commercial insurance). Here’s an estimated breakdown:
CPT Code | Service Time | Reimbursement Rate |
99212 | 10 minutes | $54.21 |
99213 | 15 minutes | $87.21 |
99214 | 25 minutes | $124.12 |
99215 | 40 minutes | $172.12 |
CPT Code | Service Time | Reimbursement Rate |
99212 | 10 minutes | $36.23 |
99213 | 15 minutes | $48.12 |
99214 | 25 minutes | $71.51 |
99215 | 40 minutes | $106.28 |
CPT Code | Service Time | Reimbursement Rate |
99212 | 10 minutes | $92 |
99213 | 15 minutes | $94 |
99214 | 25 minutes | $96 |
99215 | 40 minutes | $152 |
To correctly bill 99212, ensure that:
Exact billing ensures proper reimbursement and reduces claim refusal. If you need help with the CPT code, consider consulting counseling medical billing services for special guidance on E and M codes and 99212 CPT billing.
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