CPT 99212: Established Patient Office Visit, Straightforward
CPT 99212 reports an established patient office or outpatient visit with straightforward medical decision making or 10-19 minutes of total time. In 2026 Medicare pays about $59.45 non-facility (1.78 total RVUs times the $33.4009 conversion factor) and about $31.06 in a facility.
- Code type
- Established patient E/M (office/outpatient)
- 2026 non-facility
- $59.45 (1.78 RVUs)
- 2026 facility
- $31.06 (0.93 RVUs)
- Time (if used)
- 10-19 minutes total on the date
What is CPT 99212 used for?
CPT 99212 is an office or outpatient visit for an established patient requiring straightforward medical decision making or 10-19 minutes of total time. Typical use is a single stable, self-limited, or minor problem, a quick recheck, or a brief focused follow-up. It is the lowest level that still requires physician-level decision making; below it, 99211 needs none.
Since the 2021 E/M overhaul you choose the level by MDM or by total time, and history and exam no longer set the code, though they must be medically appropriate. An established patient is one seen by you, or by a same-specialty and subspecialty physician in your group, within the prior three years.
How much does 99212 pay in 2026?
99212 carries 1.78 non-facility RVUs and 0.93 facility RVUs. At the 2026 conversion factor of $33.4009:
| Setting | Total RVUs | 2026 Medicare allowed |
|---|---|---|
| Non-facility (office) | 1.78 | ~$59.45 |
| Facility | 0.93 | ~$31.06 |
Medicare pays 80 percent of the allowed amount after the deductible; the patient or secondary owes the 20 percent coinsurance. Check your locality with the Medicare fee calculator.
What documentation supports 99212 over 99213?
Bill 99212 when the record shows straightforward MDM: usually one self-limited or minor problem, minimal or no data reviewed, and minimal risk. If the note documents a stable chronic illness, two or more minor problems, or an acute uncomplicated illness with some data review, the visit meets low complexity and belongs at 99213, about $36 more per visit. Example: a brief recheck of a resolving minor rash with no medication change and no labs is a clean 99212 at about $59.45.
How does 99212 fit the established-patient family?
99212 is the floor of physician-level established visits. The common error is the opposite of upcoding: chronically parking visits at 99212 when the documented problem count and data would support 99213. That habitual downcoding costs a busy practice thousands per provider per year.
Frequently asked questions
By time, 99212 requires 10-19 minutes of total time on the date of service, including chart review, the encounter, and same-day documentation. If you code by MDM instead, straightforward complexity controls, typically a single self-limited or minor problem.
The 2026 national non-facility allowed amount is about $59.45 (1.78 total RVUs times $33.4009). In a facility it is about $31.06 (0.93 RVUs). Medicare pays 80 percent after the deductible.
99212 is straightforward MDM (10-19 minutes), usually one minor problem. 99213 is low MDM (20-29 minutes), typically a stable chronic condition or an acute uncomplicated illness with some data review. The gap is about $36 per visit, so accurate leveling matters at panel scale.
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.
Stop losing revenue to problems like this.
A free billing audit shows exactly where your practice is leaking money — no cost, no commitment.
