CPT 99211 is the lowest-level office visit for an established patient, and the only office E/M code that may not require a physician or other qualified health care professional to be present. It is usually a short visit with clinical staff, such as a nurse blood pressure check or wound check. Since 2021 it has no time or medical decision making requirement.
CPT 99211 description
99211 is an office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional. Unlike 99212 to 99215, it is not chosen by MDM or by time.
Office visit levels at a glance
| Code | Medical decision making | Or total time on the date of the visit |
|---|---|---|
| 99211 | Not required (usually clinical staff) | Not used |
| 99212 | Straightforward | 10 minutes or more |
| 99213 | Low | 20 minutes or more |
| 99214 | Moderate | 30 minutes or more |
| 99215 | High | 40 minutes or more |
Typical 99211 visits
- A nurse blood pressure check for an established patient, with the reading reviewed under the provider’s plan of care.
- A wound check or dressing change by clinical staff, within an existing treatment plan.
- Patient education by a nurse, such as teaching an established patient to use a glucose meter or inhaler, as part of the provider’s plan.
Medicare incident-to rules for 99211
When clinical staff perform a 99211 for a Medicare patient, it is billed under the provider as an incident-to service. In general that means the patient is established, the provider started the course of treatment, and the provider supervises. For services furnished after December 31, 2025, CMS permanently allows that direct supervision to be virtual, through real-time audio and video, for 99211 when the staff are employed by the billing practitioner (Bass, Berry & Sims summary (opens in a new tab)). New problems are not incident-to and need a visit with the provider.
When not to bill 99211
- Only an injection was given: bill the administration code (such as 96372) and the drug, not 99211.
- The provider saw the patient: choose 99212 to 99215 by MDM or time instead.
- New patients: 99211 is for established patients only.
- No medically necessary service: a prescription pickup or a form drop-off is not a visit.
Documentation that supports 99211
- Why the patient was seen and how it fits the provider’s plan of care
- What the staff member did and found, such as vital signs or wound appearance
- Any provider review or instruction
- The supervising provider, for Medicare incident-to billing
Frequently asked questions
Can 99211 be billed by time?
No. Since 2021, time is not used to select 99211.
Can a physician bill 99211?
Yes, but when the physician or other qualified professional performs the visit, the documentation usually supports at least 99212.
Related guides
- CPT 99213: low-complexity established visit
- CPT 99214: moderate-complexity established visit
- 99213 vs. 99214: how to choose the level
- CPT 99215: high-complexity established visit
- CPT 99204: moderate-complexity new patient visit
- CPT 99203: low-complexity new patient visit
- CPT 99205: high-complexity new patient visit
- CPT 99212: straightforward established visit
- CPT 99202: straightforward new patient visit
- CPT 99417: prolonged office visit add-on
- Primary care billing services
- Medical coding services
CPT is a registered trademark of the American Medical Association. This guide summarizes the office visit E/M rules in effect since 2021, with the 2024 time wording, and the CMS Evaluation and Management Services guide (MLN006764) (opens in a new tab). Payer policies and your documentation decide what is billable.
Nurse visits slipping through?
We set up nurse visit billing that follows incident-to rules, so legitimate 99211 visits are captured and paid.