99211—Established patient office visit, level 1 (nurse visit)
CPT 99211 is a Level 1 office visit for an established patient that may not need a physician present, the minimal nurse-visit code with no time or decision-making requirement.
Reviewed by the ClinicsFlows editorial team · Updated July 14, 2026 · How we source this
Quick Facts
Code
99211
Category
Category I
Section
Evaluation & Management
Last reviewed
2026
What 99211 covers
99211 is the lowest level of office visit for an established patient, and the only one that may not need a physician or advanced provider in the room. People call it the nurse visit code. Clinical staff like a nurse or medical assistant usually handles it, under a physician's supervision, for something quick and low-risk.
Typical uses are a blood pressure recheck, a warfarin or INR check at an anticoagulation clinic, a wound look, or a short medication-response check. Since 2021, 99211 has no time requirement and no decision-making level. That makes it the odd one out in the office visit family, where every other code runs on time or complexity. The trade-off is that it pays the least, about the size of a copay.
The visit still has to be a real, separate service, and the chart has to show it. 99211 isn't a code for handing over a refill at the front desk, or for the shot itself when a patient comes in only for an injection. To bill it under the physician at the full rate, the practice also has to meet Medicare's incident-to rules.
Who uses it and when
Primary care and specialty clinics lean on 99211 for staff-run check-ins. A patient on blood pressure medication stops in so the nurse can take a reading, ask about side effects, and flag anything for the doctor. An anticoagulation patient comes in for a finger-stick INR and a dose review. Each is a small but real assessment, documented and tied to the patient's care.
Where it goes wrong is billing 99211 for something that isn't a separate service. A patient who shows up only for a flu shot gets the injection code, not a nurse visit on top of it. The two bundle under NCCI edits, and no modifier splits them unless the nurse also did a distinct assessment. A refill handled over the phone isn't a 99211 either, since the code needs an in-person, face-to-face encounter.
Documentation requirements
- A short note showing a real, face-to-face service happened, not just a task like a refill or a phone message.
- The reason for the visit and what the staff member checked or assessed.
- Any findings, readings, or patient-reported symptoms, plus what was done or passed to the provider.
- The name of the staff member who saw the patient and the supervising physician.
- For incident-to billing, evidence the physician was in the office suite and the service followed an established plan.
- If billed with another service the same day, what made the 99211 separately identifiable.
Common billing mistakes
Common modifiers with 99211
Modifiers change how a payer reads the code. These are the ones billers most often attach to 99211, and why.
Special billing rules for 99211
Rules that go beyond the basics — how 99211 interacts with add-on codes, supervision, and place of service. These are the ones that most often trip up a claim.
Incident-to billing
To bill 99211 under the physician at the full rate, the visit must follow an established plan of care with the physician in the office suite and available. Miss that and it may not be payable under the doctor's number.
Must be separately identifiable
When 99211 lands the same day as an injection or vaccine, it needs a real, separate assessment with modifier 25. Billing it for the shot itself gets denied under NCCI edits.
No time or decision-making level
99211 is the one office visit code with no time threshold and no complexity level. It's defined by being a minimal, established-patient service, often done by staff.
Reimbursement & payer behavior
Work RVU
0.18
Total RVU
0.73
Medicare rate*
~$24.00
Global period
XXX
Concept doesn't apply to this code
*Approximate national non-facility rate, sourced from the CMS Medicare Physician Fee Schedule. Actual payment varies by locality and payer contract. Verify against the current fee schedule before billing.
Under the 2026 Medicare fee schedule, 99211 pays about $24 in an office setting, the lowest of any office visit code. In a facility it pays only a few dollars, since the facility bills its own portion. That small amount is exactly why the code gets overlooked, but it adds up across a busy clinic running dozens of nurse checks a week.
The catch is that low-dollar codes still get audited, and 99211 is a frequent target because it's easy to bill without real content behind it. Payers deny it when it's stacked on an injection, tied to no clear service, or billed without meeting incident-to rules. A one-line note that shows a genuine assessment is what keeps the payment. Rates are approximate and change each year.
Frequently asked questions about 99211
What is CPT code 99211?▼
It's the minimal, Level 1 visit for a patient the practice already knows, and the only office E/M that staff can run without a provider in the room. It's widely called the nurse visit code. Typical uses are a blood pressure check, an INR check, or a quick medication follow-up. It carries no time or decision-making requirement.
Is CPT 99211 deleted?▼
No. 99211 is active and payable in 2026. The confusion comes from the 2021 E/M overhaul, which dropped the old 'about 5 minutes' time and the 'minimal problem' wording. Those phrases went away, but the code did not.
Does 99211 have a time requirement?▼
No. Under the 2021 rules, the code carries no typical time and no complexity level, which sets it apart from every other office E/M. You bill it for a minimal, in-person service by staff, not by counting minutes. The other established codes, 99212 through 99215, do run on time or complexity.
What modifier is used with 99211?▼
Modifier 25 is the main one. You add it when 99211 is a separate, identifiable service on the same day as another procedure, like an injection. Without a distinct assessment and modifier 25, the visit bundles into the other service and gets denied.
How much does 99211 reimburse?▼
About $24 in an office setting under the 2026 Medicare fee schedule, the lowest office visit rate. A hospital-based visit pays far less, only single digits. Commercial plans set their own amounts, and your local cost index moves the final number.
What are the billing guidelines for 99211?▼
Bill it for a real, face-to-face service by clinical staff, documented with what was checked and why. Meet incident-to rules to bill it under the physician. Don't use it for a phone call, a refill, or the injection itself. If it rides with another service, it has to be separately identifiable with modifier 25.
What is the difference between 99211 and 99212?▼
A provider and a decision. 99211 can be done by staff with no provider in the room and no complexity level. 99212 requires a physician or advanced provider and either straightforward decision-making or 10 to 19 minutes. 99212 also pays more than double.
What is CPT code 99212, and what does it mean?▼
99212 is a low-level office visit for an established patient that needs a provider. You bill it for straightforward medical decision-making or 10 to 19 minutes of total time on the visit day. It fits a simple, single-problem visit, like a quick recheck with little to weigh. Under the 2026 Medicare fee schedule it pays about $59.
What are CPT codes 99211 through 99215?▼
They're the five levels of office visit for established patients, from lowest to highest. 99211 is the minimal nurse visit; 99212 through 99215 climb by decision-making or time, with 99215 the most complex. A provider picks the level from the work the visit actually took. Higher levels pay more and draw more audit attention.
More codes in the same specialties
Sources
- Fee and RVU data: CMS Medicare Physician Fee Schedule Lookup (2026 code set)
- Diagnosis codes: ICD-10-CM, published by CMS
- Telehealth status: Medicare Telehealth Services List
- Code set governance: American Medical Association — CPT
- How we research and verify: our editorial policy
CPT® is a registered trademark of the American Medical Association. Content on this page is original educational writing, not a reproduction of AMA-copyrighted descriptions. Reimbursement figures are approximate and for reference only. Verify with current payer contracts before billing.