CPT 99212 Description, Billing Rules, & Use Cases

CPT 99212 is used to bill for an office or other outpatient visit with an established patient that requires straightforward medical decision making and/or at least 10 minutes of total time spent on the date of the encounter

This code represents the lowest-level provider-delivered E/M visit for established patients, above the staff-level 99211. It applies when the encounter involves minor or self-limited problems but still requires direct evaluation and management by a physician, nurse practitioner (NP), or physician assistant (PA).

The visit may include:

Reviewing and updating a brief patient history
Performing a focused physical examination
Providing simple medical decision making for a minor problem
Offering patient or caregiver education and reassurance
Ordering basic laboratory or diagnostic tests
Documenting the encounter in the medical record

What is CPT Code 99212?

CPT 99212 is an evaluation and management (E/M) code for established patient office or outpatient visits that require straightforward medical decision making (MDM) or at least 10 minutes of total provider time on the date of the encounter

Key points about CPT 99212:

It is used when the patient presents with a minor or self-limited problem (e.g., cold symptoms, simple rash, medication review).
The provider must personally deliver the service — unlike CPT 99211, which can be billed for staff-level encounters under supervision.
The 2024 guideline update replaced the old 10–19 minute range with “10 minutes must be met or exceeded.”
Total time includes both face-to-face and non–face-to-face activities, such as chart review, documentation, ordering tests, and patient counseling.
Encounters requiring more time or higher-level decision making may qualify for 99213 or higher.

In summary: CPT 99212 is the entry-level provider E/M service for established patients — a brief, straightforward visit requiring minimal provider involvement beyond 99211.

CPT 99212 Time Thresholds and Code Combinations

CPT 99212 applies when an established patient office or outpatient visit requires at least 10 minutes of provider time or straightforward medical decision making (MDM).

Important to Note:

2024 guidelines specify: 10 minutes must be met or exceeded.
If less than 10 minutes of provider time is spent, or the service is minimal and staff-only, bill 99211 instead.
If the encounter involves more time or complexity, consider 99213 or higher.

Table showing established patient office/outpatient E/M codes. 99211 is for minimal staff-level service. 99212 requires at least 10 minutes of provider time or straightforward MDM. 99213–99215 progress upward from 20 to 54 minutes, reflecting increasing complexity.

When to Use CPT 99212: Common Scenarios and Use Cases

CPT 99212 is appropriate when a physician, nurse practitioner (NP), or physician assistant (PA) provides a brief, straightforward visit with an established patient that requires at least 10 minutes of total provider time.

Here are examples of how CPT 99212 is used in practice:

Simple Rash Evaluation

Stable Hypertension Follow-Up

Medication Side Effect Check

Simple Rash Evaluation

A primary care physician allocates time to:

Review brief history of onset and symptoms
Perform a focused skin exam
Prescribe topical medication and provide patient education

Total time: 12 minutes
Billing: 99212

Middle-aged male patient consulting with senior doctor in modern clinic, representing patient engagement and preventative health discussions in primary care

Stable Hypertension Follow-Up

A nurse practitioner (NP) allocates time to:

Review blood pressure log and confirm medication adherence
Perform a brief physical assessment
Adjust lifestyle recommendations and document the visit

Total time: 15 minutes
Billing: 99212

Female doctor recording blood pressure reading for young woman during routine checkup, illustrating preventive care and vital sign monitoring in primary care settings

Medication Side Effect Check

A physician assistant (PA) allocates time to:

Discuss patient’s new prescription and reported mild side effects
Review chart for labs and prior notes
Provide reassurance, update the medication plan, and document findings

Total time: 18 minutes
Billing: 99212

Nurse reviewing a care plan with an older patient in a comfortable setting, illustrating Chronic Care Management (CCM) care plan creation and optimization.

CPT 99212 Billing Requirements and Eligibility

To bill CPT 99212, the following conditions must be met:

Patient Eligibility

The patient must be an established patient (seen by the same provider group within the past three years).
The encounter must involve a minor or self-limited problem, appropriate for a brief evaluation.

Provider Eligibility

The service must be delivered personally by a physician, nurse practitioner (NP), or physician assistant (PA).
Unlike 99211, 99212 cannot be billed solely for staff-level encounters — the billing provider must be directly involved.

Service Requirements

Time-based option: At least 10 minutes of total provider time must be documented.
MDM-based option: Straightforward medical decision making (limited data, minimal risk, and low complexity problems).
Activities may include chart review, history taking, focused exam, counseling, ordering tests, or documenting the visit.
If less than 10 minutes are spent, or only minimal services are performed by staff, bill 99211 instead.
If more time or higher complexity is involved, bill 99213 or higher.

Code Comparison

99211 vs 99212: 99211 is a minimal service that may be staff-only. 99212 requires provider involvement and at least 10 minutes or straightforward MDM.
99212 vs 99213: 99212 applies to visits requiring 10–19 minutes or minimal complexity. 99213 is for 20–29 minutes or low-complexity MDM

CPT 99212 Billing Documentation Checklist

To support compliant billing for CPT 99212, your records should include:

Established patient status confirmed (seen by the practice within the past three years).
Reason for the encounter documented (e.g., minor problem, routine follow-up, medication side effect check).
Provider involvement clearly noted (physician, NP, or PA must perform the service).
Time documentation (if coding by time):
- At least 10 minutes of total provider time
- Activities performed (chart review, exam, counseling, documentation, ordering tests)
Medical decision making (if coding by MDM):
- Straightforward complexity with minimal risk
- Limited data reviewed or analyzed
- Minor/self-limited problem addressed
Encounter details recorded: history, exam findings, treatment plan, and patient education provided.
Provider attestation confirming services were personally performed and accurately documented.
Non-overlap statement if other services are billed the same day, to avoid duplication.

Common CPT 99212 Billing Mistakes (and How to Avoid Them)

❌ Billing Without 10 Minutes of Provider Time

If coding by time, encounters must document at least 10 minutes. Anything less should be reported as 99211.

❌ Using 99212 for Staff-Only Visits

Unlike 99211, 99212 requires direct involvement by a physician, NP, or PA. Staff-only services do not qualify.

❌ Under-Documenting MDM

If coding by MDM, records must demonstrate straightforward decision making: a minor/self-limited problem, minimal risk, and limited data reviewed.

❌ Confusing 99212 With 99213

99212 is for brief, simple encounters (10–19 minutes or straightforward MDM). Use 99213 if 20+ minutes or low-complexity MDM applies.

❌ Billing for Administrative Work Alone

Tasks such as scheduling, form completion, or medication pick-up without evaluation or management do not meet 99212 requirements.

❌ Incorrect Service Setting

CPT 99212 is valid only for office or outpatient visits. Inpatient, ED, or observation services require different E/M codes.