Description 2021

The 2021 description of CPT 99211 was as follows: “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. Usually, the presenting problem(s) are minimal.

What modifier can be used with 99211?

Effective for claims processed on or after March 16, 2020, we will deny reimbursement for evaluation and management (E&M) services billed with Current Procedural Terminology (CPT®) code 99211 appended with modifier 25 when billed alone or with another procedure code on the same date of service.

Is CPT 99211 still valid?

CPT code 99211 (established patient, level 1) will remain as a reportable service.

Who can bill for 99211?

Physicians can report 99211, but it is intended to report services rendered by other individuals in the practice, such as a nurse or other staff member. Unlike other office visit E/M codes, a 99211 office visit does not have any specific key-component documentation requirements.

Does Medicare pay for 99211?

Does Medicare Approve 99211? Yes, Medicare considers this routine. If you are an approved Medicare provider you can bill this code.

Does Medicare pay for CPT code 99211?

The established-patient rule also is important because Medicare applies the concept of incident-to services for 99211, meaning a provider previously furnished a direct, personal, professional service to initiate a course of treatment, and the 99211 service being performed is an incidental part of that care plan.

Can a medical assistant Bill a 99211?

A: The 99211 E/M visit is a nurse visit and should be used only by a medical assistant or a nurse when performing services such as wound checks, dressing changes or suture removal. CPT code 99211 should never be billed for physician, physician assistant or nurse practitioner services.

Can nurses Bill 99211?

You can either bill for the 99211 plus the medications or bill for the injection plus the medications. When the nurse must make an evaluation of the patient (e.g., when giving a depo-progesterone shot, the nurse must consider, “might the patient be pregnant?”), then our practice uses the 99211.

What is the difference between CPT code 99211 and 99212?

CPT 99211 Description: An outpatient visit or office visit of an established patient. A qualified healthcare professional (physician or other) may not be required. CPT 99212 Description: An outpatient visit or office visit of an established patient. The visit involves management and evaluation.