cpt 99215, cpt code 99215, 99215 cpt code

CPT 99215 | Established Patient | E/M | Office & Outpatient | 40-54 Minutes

CPT code 99215 is used for an office or outpatient visit with an established patient for evaluation and management that requires a high level of medical decision-making and a total time of 40-54 minutes spent on the encounter.

What Is CPT Code 99215?

CPT 99215 is a medical billing code that describes an office or outpatient visit with an established patient for evaluation and management.

During this visit, the provider will spend 40-54 minutes on the encounter, including in-person and non-in-person activities.

The provider will also need to make a high level of medical decisions based on factors such as the number and complexity of the patient’s problems, the amount and complexity of data to review, and the potential risks involved in managing the patient’s condition.

The provider may also take a medically appropriate history and/or examine during this visit.

Description

The CPT book describes CPT code 99215 as: “Office or other outpatient visits for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.”

Procedure

The provider performs a medical evaluation and management service for an established patient in the provider’s Office or another outpatient setting.

The provider spends a total of 40-54 minutes on the encounter, including both face-to-face and non-face-to-face activities such as;

  • preparing for the visit,
  • counseling and educating the patient or caregiver,
  • reviewing tests, 
  • communicating with other healthcare providers,
  • performing the exam or evaluation,  
  • documenting the encounter, 
  • interpreting and communicating results, 
  • ordering tests, and
  • coordinating care.

The level of medical decision-making involved in the encounter is high and is determined by factors such as the number and complexity of problems addressed the amount and complexity of data to review and analyze, and the risk of complications, morbidity, and mortality related to patient management.

How To Use CPT 99215

CPT code 99215 can only be billed for office or other outpatient visits for E/N services for an established patient that takes between 40 and 54 minutes. You may add on code CPT 99417 for prolonged services.

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