99212 coding do's and don'ts
Medicare's 2026 national physician rates are $59.45 for a 99212 and $95.19 for a 99213. A refill for one stable chronic illness supports the 99213.
Head of Growth and Operations, JotPsych
Your patient's depression is stable, and you renewed the antidepressant in a 12-minute visit. You're about to bill a 99212.
At Medicare's 2026 national physician rates, a 99213 pays $35.74 more than a 99212. Nurse practitioners' national rates are 85% of the physician rates: $50.53 for a 99212 and $80.91 for a 99213. Check whether your visit managed a prescription for a chronic illness before you bill a 99212.
Bill 99212 for one minor problem with minimal data.
Count all your time on the date.
Write your time in the note.
Bill 99212 for a refill of a stable chronic illness.
Count travel or separately billed work.
Bill 99212 when your total time reaches 20 minutes.
Each do and don't follows the American Medical Association table or Medicare's evaluation and management guide. A refill for one stable chronic illness puts the problem and the risk at low or above, so the visit reaches a 99213.
Three do's for a 99212
- Bill 99212 for one minor problem with minimal data. The American Medical Association (AMA) table rates three elements of medical decision making (MDM): the problems, the data, and the risk. Two of the three set the level. With "1 self-limited or minor problem" and "Minimal or none" for data, the visit stays at straightforward MDM, a 99212.
- Count all your time on the date. The Centers for Medicare & Medicaid Services (CMS) counts preparing to see the patient, ordering medications, documenting in the record, and coordinating care. The code's descriptor sets 10 minutes for a 99212.
- Write your time in the note. CMS asks you to record "a start and stop time or the total time," and only the time your note shows can support the code.
Three don'ts for a 99212
- Don't bill 99212 for a refill of a stable chronic illness. One stable chronic illness is a low-level problem, and prescription drug management is moderate risk, so two of three elements reach the low level, a 99213.
- Don't count travel or separately billed work. CMS leaves out "Traveling" and "Performing other services you reported separately." Count only the time that belongs to your visit.
- Don't bill 99212 when your total time reaches 20 minutes. Twenty minutes supports a 99213. Check the total before you pick the code.
| Code | Problems addressed, one example | Time on the date, in minutes | National physician rate, 2026 |
|---|---|---|---|
| 99212 | 1 self-limited or minor problem | 10 or more | $59.45 |
| 99213 | 1 stable chronic illness | 20 or more | $95.19 |
| 99214 | 2 or more stable chronic illnesses | 30 or more | $135.61 |
| 99215 | 1 chronic illness with severe exacerbation | 40 or more | $192.39 |
The American Medical Association table pairs each problem level with data and risk, and two of three elements set the code. A refill for one stable chronic illness lands on the 99213 row, not the 99212 row.
For a 99212, PayerPrice's national averages are $51.48 at Aetna, $53.99 at UnitedHealthcare, $56.23 at Blue Cross / Anthem, and $64.89 at Cigna. None of the four averages names a clinician type.
Enter 99212 in JotPsych, and JotAudit marks it Review Suggested when your note doesn't match the code.
Book 15 minutes- Centers for Medicare & Medicaid Services, PFS Relative Value Files: 2026 national physician rates and short descriptors (such as "Office o/p est mod 30 min") from the October 2026 release (RVU26D), file PPRRVU2026_Oct_nonQPP, conversion factor 33.4009.
- Legal Information Institute, Cornell Law School, 42 U.S.C. 1395l(a)(1)(N) and (O): Medicare pays 80 percent of the lesser of the actual charge and the fee schedule amount for a physician's service, and 80 percent of "the lesser of the actual charge or 85 percent of the fee schedule amount" for a nurse practitioner's, read October 2, 2026.
- American Medical Association, CPT evaluation and management office visit revisions, Table 1: Levels of Medical Decision Making, effective January 1, 2021.
- Centers for Medicare & Medicaid Services, Medicare Learning Network, Evaluation and Management Services (MLN006764), May 2026.
- PayerPrice, CPT 99212 fee schedule by payer, national averages by payer, last verified October 2026; the page names no clinician type.