CPT 99212: Established Patient Office Visit, Straightforward MDM

CPT 99212 is an office or outpatient visit for an established patient that requires straightforward medical decision making, or at least 10 minutes of the provider’s total time on the date of the visit. It fits short visits for one minor problem, such as a quick recheck or a simple self-limited illness.

CPT 99212 description

99212 is an established patient office or other outpatient visit with a medically appropriate history and/or examination and straightforward medical decision making. When time is used to choose the level, 10 minutes must be met or exceeded.

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

Straightforward medical decision making

Two of the three elements must reach at least straightforward. Here is how it compares with the next level up:

Element	Straightforward (99202 / 99212)	Low (99203 / 99213)
Problems addressed	1 self-limited or minor problem	2 or more self-limited or minor problems; or 1 stable chronic illness; or 1 acute, uncomplicated illness or injury; or 1 stable acute illness
Data reviewed and analyzed	Minimal or none	At least 1 of: any 2 of reviewing prior external notes, reviewing a test result, or ordering a test; or an assessment requiring an independent historian
Risk of patient management	Minimal risk of morbidity from further testing or treatment	Low risk of morbidity from further testing or treatment

Typical 99212 visits

• A recheck of a minor problem that has resolved, such as a healed insect bite or a wound check with no complications.
• A cold or other self-limited illness managed with reassurance and over-the-counter care.
• A brief visit for a single minor concern with no tests ordered or reviewed.

If you review a test result or outside notes, or manage a stable chronic illness, the visit may support 99213 instead.

99212 vs. 99211

99211 is the lowest established patient level. It does not require a physician or other qualified professional to be present and is usually performed by clinical staff, such as a blood pressure check by a nurse. Since 2021, 99211 has no time threshold or MDM requirement, so it cannot be chosen by time. Medicare incident-to rules apply when clinical staff provide it. 99212 requires a visit with the physician or qualified professional.

Billing 99212 by time

Count the practitioner’s total time on the date of the visit, including:

• Preparing to see the patient, such as reviewing tests
• Getting or reviewing separately obtained history
• Performing a medically appropriate exam
• Counseling and educating the patient, family or caregiver
• Ordering medications, tests or procedures
• Referring and communicating with other professionals (when not separately reported)
• Documenting in the record
• Independently interpreting results (when not separately reported) and coordinating care

Frequently asked questions

Is 99212 used much?

Less than 99213 and 99214, which cover most follow-up visits. Billing 99212 by habit for visits that involved test review or a chronic illness is a common source of under-coding.

Can 99212 be billed by telehealth?

Yes, with payers that cover it. See our POS 02 vs. POS 10 guide for the place of service.

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 99202: straightforward new patient visit
• CPT 99211: nurse visit for an established patient
• 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.