What your 99212 actually pays: Medicare's 2026 rate, and why the code is rare

The level-2 established-patient visit is the shortest, lowest-paying code in the office-visit family. Medicare raised it 8.1% for 2026. Most practices should barely ever use it, and if you use it a lot, that is worth a second look.

The code, and why it barely gets used

CPT (Current Procedural Terminology) code 99212 is the level-2 established-patient office visit: 10 to 19 minutes of total time on the date of the visit, or medical decision-making (MDM) classified as straightforward. Since 2021, Medicare lets a clinician pick the visit level by either total time or MDM complexity, whichever fits better, without the older requirement to document a full history and exam for every level.

In practice, straightforward MDM is a narrow box: one self-limited problem, no prescription drug management, minimal risk. A psychiatric mental health nurse practitioner (PMHNP) or psychiatrist doing medication management almost never lands here, because reviewing a controlled substance or adjusting any psychiatric medication already pushes the visit to at least low complexity, which is a 99213. A stable patient on a med that has not moved in a year, seen briefly to renew a prescription with nothing new to manage, is one of the few visits that genuinely qualifies.

What Medicare pays in 2026

Medicare pays $59.45 nationally for 99212 in 2026 (non-facility, national locality), up from $54.99 in 2025, an increase of 8.1%. The number underneath that move is the Medicare conversion factor, a single dollar multiplier that CMS applies to every code on the physician fee schedule. It fell for five straight years, from a peak of $36.09 in 2020 to $32.35 in 2025, before this year's rule reversed course: $33.40 for 2026, a 3.26% increase. E/M (evaluation and management) codes were explicitly exempted from a separate 2.5% efficiency cut CMS applied elsewhere in the 2026 rule, which is part of why the increase here outpaces the conversion factor alone.

What commercial payers pay

PayerPrice, which aggregates the machine-readable files payers must publish under federal price transparency rules, shows national average commercial rates for 99212 ranging from $51.48 (Aetna) to $64.89 (Cigna) as of August 2026, both close to or above the Medicare rate. These are national averages; individual contracts vary by region and specialty, and the underlying provider-level data PayerPrice shows for UnitedHealthcare alone ranges from roughly $23 to $114 depending on the specific contract.

The so-what

A high volume of 99212s is a signal worth checking, not a target. If a meaningful share of your established-patient panel is coded 99212, ask whether those are truly straightforward, no-medication-change visits, or whether they are actually low-complexity visits (99213) that are being undercoded out of habit, a cautious EHR (electronic health record) default, or uncertainty about what MDM level a visit supports. Undercoding a med management visit to 99212 when the documentation supports 99213 gives away real revenue on every single occurrence.

• Pull your 99212 share. If more than a few percent of established-patient E/M visits land here, sample five charts and check whether the documented complexity actually matches straightforward MDM.
• Check the EHR default. Some templates default to the lowest code when a field is left blank. That default costs money every time a clinician does not override it.