October 9, 2025
CPT Code 99211 is the lowest-level Evaluation and Management (E/M) office or outpatient visit code. It is specifically used for an established patient visit that requires minimal clinical decision-making and may not even require the physicianβs presence. Often referred to as the βnurse visit code,β 99211 plays an important role in medical billing when simple, medically necessary services are provided.
This code applies when staff provide simple, medically necessary services such as:
Unlike higher-level E/M codes, CPT 99211 does not always require physician involvement. Services can be performed by:
However, 99211 must meet βincident-toβ requirements for Medicare billing, meaning the physician must be present in the office suite.
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The Medicare reimbursement rate for CPT 99211 is around $24 per claim, but the amount may vary based on location and payer policies.
Estimated Reimbursement Rates for 2025
Feature | 99211 | 99212 |
Patient Type | Established | Established |
Complexity | Minimal | Low |
Physician Involvement | Not always required | Usually required |
Documentation | Brief | Expanded problem-focused |
Typical Use | Nurse-only visits | Simple physician visits |
When a separately identifiable E/M service is provided on the same day as another procedure, Modifier 25 may be appended to 99211. Example:
CPT Code 99211 may seem like a small service code, but it helps providers capture reimbursement for simple, medically necessary visits. To ensure compliance, practices must maintain clear documentation, understand payer rules, and apply modifiers when necessary.
Need help maximizing reimbursement for CPT Code 99211 and other E/M services? Contact Cures Medical Billing today for expert billing and compliance support.
CPT 99211 represents a minimal E/M service for an established patient, often handled by nursing staff, that still requires documentation of medical necessity.
Yes, 99211 is still active, billable, and covered by Medicare when guidelines are met.
99211 is for minimal-complexity visits that donβt require a physician, while 99212 requires low-level physician involvement and expanded documentation.
A modifier is not always required, but Modifier 25 may be necessary when billing alongside procedures.
Reimbursement vary, but 99211 generally pays the lowest among E/M codes due to minimal complexity.
Yes, Medicare covers 99211 when it qualifies as a medically necessary, incident-to service.
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