CPT 99211 | Office/Outpatient | E/M | Non-Physician | Established Patient
CPT code 99211 describes an office or outpatient visit for evaluating and managing an established patient that a nurse or other provider may conduct rather than a physician or other qualified healthcare professional.
What Is CPT Code 99211?
CPT 99211 describes an office or outpatient visit to evaluate and manage an established patient. This means that the patient has previously received medical care and is returning for follow-up or ongoing treatment.
The description of CPT 99211 notes that the visit may not require the presence of a physician or other qualified healthcare professional. This means that the visit may be conducted by a nurse or other provider rather than a physician.
The physician or qualified healthcare professional is qualified through their education, training, licensing, and facility privileges to provide professional services within their scope of practice.
Description
The CPT book describes CPT code 99211 as: “Office or other outpatient visits for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional.”
Procedure
A nurse or other provider offers a service to an established patient without needing a physician or other qualified healthcare professional to be present.
This is because the physician or qualified healthcare professional is qualified through their education, training, licensing, and facility privileges to provide professional services within their scope of practice.
They can independently report these services. On the other hand, clinical staff members, who work under the supervision of a physician or qualified healthcare professional, are allowed to perform or assist in the performance of certain professional services. Still, they need to report these services themselves. Laws, regulations, and facility policies determine this.
How To Use CPT 99211
CPT 99211 may be used in cases where the patient is seen by a physician, nurse, or nonphysician practitioner (NPP), such as a physician assistant or nurse practitioner. It’s important to note that, in practice, visits with physicians and NPPs are typically eligible for a higher level CPT code because of the additional training and expertise they possess.
This is because physicians and NPPs are qualified healthcare professionals who have completed advanced education and training in their fields. As such, they can provide a broader range of services and may require more time to complete a visit with a patient.
