CPT 99211 Description, Billing Rules, & Use Cases
CPT 99211 is used to bill for an office or other outpatient visit with an established patient that involves a minimal level of service and may not require the presence of a physician. This code is often referred to as the “nurse visit” code because services are frequently provided by clinical staff under the supervision of a physician or other qualified healthcare professional.
CPT 99211 applies to brief encounters where the patient’s presenting problem is minor or self-limited and the evaluation and management (E/M) service is straightforward.
The visit may include:
- Checking vital signs and recording basic clinical information
- Simple follow-up or monitoring for a stable condition
- Administering an injection or performing a simple treatment
- Providing patient education or answering questions about medications
- Documenting the encounter in the medical record
What is CPT Code 99211?
CPT 99211 is an evaluation and management (E/M) code used for established patient office or outpatient visits that require only a minimal level of service. Unlike other E/M codes, it does not specify a required time or decision-making complexity.
Key points about CPT 99211:
- It is designed for simple, low-intensity visits, often involving routine follow-up or straightforward care tasks.
- Services can be provided by clinical staff under the supervision of a physician, nurse practitioner (NP), or physician assistant (PA).
- No physician presence is required, but documentation must demonstrate that the service was necessary and performed under supervision.
- Typical patient encounters billed under 99211 include checking vital signs, medication refills, blood pressure checks, injections, or basic patient education.
- If a provider directly delivers more involved evaluation or management, higher-level codes (99212–99215) should be considered instead.
In summary: CPT 99211 is often called the “nurse visit” code because it covers minimal services for established patients, usually handled by staff with limited provider involvement.
CPT 99211 Time Thresholds and Code Combinations
Unlike other E/M codes, CPT 99211 does not require a specific time threshold or medical decision-making level. It is used when the service is so minimal that it does not meet the criteria for higher-level codes (99212–99215).
Important to Note:
- No minimum time is required.
- Service must still be medically necessary and documented.
- Used for simple or brief encounters, often performed by clinical staff under provider supervision.
- If the provider personally spends more time or complexity is higher, bill 99212 or above instead.
When to Use CPT 99211: Common Scenarios and Use Cases
CPT 99211 is appropriate when clinical staff (e.g., RN or LPN) working under the supervision of a physician, NP, or PA provide a minimal service to an established patient in the office or outpatient setting; a physician/QHP need not be present for the encounter.
Here are examples of how CPT 99211 is used in practice:
Blood Pressure Check & Medication Adherence Review
A registered nurse (RN) allocates time to:
- Record vital signs and confirm home BP log entries
- Assess medication adherence and side effects
- Document findings and route updates to supervising provider
Total time: 8 minutes
Billing: 99211
Injection Administration With Brief Monitoring
A licensed practical nurse (LPN) allocates time to:
- Verify orders and administer a prescribed injection
- Observe for immediate adverse reaction and provide aftercare instructions
- Document medication lot/expiration and patient response
Total time: 6 minutes
Billing: 99211
Quick Medication Refill & Education Touchpoint
A medical assistant (under supervision, per policy/payer rules) allocates time to:
- Review chart for recent lab/results and confirm stability
- Provide brief education on dosing and missed-dose steps
- Update medication list and document encounter for provider review
Total time: 10 minutes
Billing: 99211
CPT 99211 Billing Requirements and Eligibility
To bill CPT 99211, the following criteria must be met:
Patient Eligibility
- The patient must be an established patient in the practice (seen by the group within the past three years).
- The encounter must involve a minimal presenting problem (e.g., stable condition follow-up, medication review, or routine monitoring).
Provider Eligibility
- CPT 99211 may be provided by clinical staff (RN, LPN, or medical assistant) under the supervision of a physician, NP, or PA.
- Direct provider presence is not required, but the supervising provider must be available and responsible for the care.
Service Requirements
- No specific time threshold is required; the visit is defined by minimal service rather than duration.
- Documentation must demonstrate that the service was medically necessary and performed under supervision.
- If the provider delivers more direct evaluation or higher-complexity decision making, bill 99212–99215 instead.
Code Comparison
- 99211 vs 99212: 99211 covers minimal staff-level encounters without provider presence. 99212 requires 10–19 minutes of provider time or straightforward MDM.
- 99211 vs nurse tasks not billed: Simple vitals or administrative tasks (without evaluation/management) are not separately billable — services must support patient care to justify 99211.
CPT 99211 Billing Documentation Checklist
To support compliant billing for CPT 99211, records should include:
- Established patient status documented (seen by the practice within the past three years).
- Reason for the encounter showing medical necessity (e.g., blood pressure check, medication refill, injection administration).
- Clinical staff involvement documented, with supervising provider identified.
- Tasks performed clearly recorded (vital signs, education, treatment provided, monitoring, etc.).
- Documentation of outcomes or patient instructions given.
- Provider supervision note confirming that the service was performed under the direction of a physician, NP, or PA.
- Attestation that the encounter qualifies as an E/M service, not just an administrative or clerical task.
- No overlap with other billed services on the same date (e.g., 99212+).
Common CPT 99211 Billing Mistakes (and How to Avoid Them)
❌ Billing Without Medical Necessity
Routine tasks like recording vitals or checking in a patient are not billable unless they directly support patient care.
❌ Using 99211 for New Patients
❌ No Supervising Provider Listed
Although a physician/NP/PA does not need to be present, documentation must show staff acted under supervision.
❌ Confusing Administrative Work With Billable Service
Tasks such as scheduling appointments or filling out forms without evaluation/management do not qualify for 99211.
❌ Upcoding or Downcoding
Reporting 99211 when the provider actually spent time on a straightforward exam or decision-making undervalues the visit. In those cases, 99212 or higher should be used.
❌ Incorrect Setting Usage
CPT 99211 is for office or outpatient visits only. Do not use it for inpatient or ED encounters.
