CPT 99211: Established Patient Office Visit, Minimal
CPT 99211 reports a minimal established patient office visit that may not require a physician's presence, often a nurse visit. It is the only office E/M code with no MDM or time requirement. In 2026 Medicare pays about $24.38 non-facility (0.73 total RVUs times the $33.4009 conversion factor).
- Code type
- Established patient E/M (minimal)
- 2026 non-facility
- $24.38 (0.73 RVUs)
- 2026 facility
- $7.68 (0.23 RVUs)
- MDM/time
- None required; must be medically necessary
What is CPT 99211 used for?
CPT 99211 is an office or outpatient visit for an established patient for a problem that is minimal and may not require a physician's presence. It is the classic "nurse visit" code: a blood-pressure recheck, a wound check, an anticoagulation follow-up, or medication counseling delivered by clinical staff. Unlike the rest of the office E/M family, it has no MDM or time threshold, only a medical-necessity requirement and a documented, separately identifiable evaluation and management element.
Because it does not require the billing physician face-to-face, 99211 is usually reported for services clinical staff perform under physician supervision. That flexibility is also its main compliance trap: the encounter still has to involve a genuine clinical assessment tied to the patient's care, not a purely administrative or technical task.
How much does 99211 pay in 2026?
99211 carries just 0.73 non-facility RVUs and 0.23 facility RVUs. At the 2026 conversion factor of $33.4009:
| Setting | Total RVUs | 2026 Medicare allowed |
|---|---|---|
| Non-facility (office) | 0.73 | ~$24.38 |
| Facility | 0.23 | ~$7.68 |
The facility rate is far lower because the facility, not the practice, bills the overhead. Small per claim, but at the volume clinics run these encounters, it is real revenue that would otherwise go uncaptured. Medicare pays 80 percent of the allowed amount after the deductible. Check locality rates with the Medicare fee calculator.
What are the billing rules and audit risk for 99211?
The service must be reasonable and medically necessary, tied to the patient's care, and captured in a note; otherwise it is not billable. Work the encounter in order:
- Confirm the patient is established, seen by your group and specialty within three years.
- Document a real, separately identifiable E/M element, an assessment and a plan action, not just a recorded vital sign.
- Make sure the service is not already bundled into another code billed that day, such as a vaccine administration or a therapeutic injection.
- For Medicare incident-to billing, ensure a supervising physician is in the office suite and the service follows an established plan of care.
When the encounter involves any real decision making by a physician or QHP, step up to 99212 or 99213, which require and reward that work.
Frequently asked questions
No. 99211 is the one office E/M code that does not require the physician's face-to-face presence, so it commonly covers clinical staff services such as a nurse blood-pressure recheck or an injection visit. However, when billed incident-to under Medicare, a supervising physician must be present in the office suite and the service must be part of an established plan of care.
The 2026 national non-facility allowed amount is about $24.38 (0.73 total RVUs times $33.4009). In a facility it is only about $7.68 (0.23 RVUs) because the facility bills the overhead. It is low, but it is legitimate revenue for staff-delivered services that would otherwise go uncaptured.
Do not bill 99211 when the only service is drawing blood for a lab, administering a vaccine with its own admin code, or a purely administrative contact. There must be a separately identifiable, medically necessary evaluation and management element, and it must be documented. Bundling 99211 onto services that already include the encounter is a common audit finding.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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