Skip to main content
Headway
Patient portalJoin as a provider

Billing and coding

How to use CPT code 99212

Code 99212 represents an existing patient appointment that’s at least 10 minutes in duration.

The 99212 code is an E/M code used by prescribing providers. For other E/M codes, visit this overview.

CPT code 99212 description

Code 99212 represents an existing patient appointment that’s at least 10 minutes in duration. It’s a prescriber code, which means it’s most commonly used by psychiatrists or nurse practitioners. 

This is is how the American Medical Association defines 99212 in the official CPT codebook:

CPT code 99212: Existing patient office visit, minimum 10 minutes

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.

As a prescriber, you can bill insurance according to time or medical decision-making (MDM). Make sure to include sufficient documentation to support the method you choose.

If you spent 15 minutes with a client but the case was especially complex or high risk, or involved reviewing or analyzing a lot of data, you may use a higher CPT code, including 99213 (low MDM), 99214 (moderate MDM), or 99215 (high MDM).

It’s important to use the code that most accurately reflects the time you spent with the patient to treat their condition, and ensure that documentation for the session supports the chosen code. 

99212 vs 99202: Existing patient vs. new patient

If you’re treating a new patient, you should use 99202 instead. A new patient is someone you have not seen in the last three years.

CPT code 99212 time frame

CPT code 99212 is a returning patient appointment of at least 10 minutes. Other time frames for a new patient should be coded with [99213] (at least 20 minutes), [99214] (at least 30 minutes), or [99215] (at least 40 minutes).

CPT code 99212 documentation

Documentation for 99212 is essentially the same as other E/M codes, but geared toward a new patient. New patient notes should always include: 

  • Problem-focused history: Document relevant information about the patient’s presenting complaint, medical history, and any other important factors
  • Problem-focused examination: Perform and document an evaluation that’s appropriate for the patient’s presenting complaint
  • Straightforward complexity medical decision making: Make a judgment about the patient’s diagnosis, create a care plan, and prescribe appropriate treatments or interventions. You can find a full table of levels and elements of MDM here.
  • If you are billing based on time, include start/stop timers.


In the example note below, the following factors are present, making 99212 the best code for billing the session:

  • Number and complexity of problems addressed: Low - 1 self-limited problem (bereavement)
  • Data reviewed/analyzed: None
  • Risk: Minimal

Patient Name: Maria Johnson

Patient DOB: 01/15/1952

Date of Service: 09/21/2024

Appointment Time: 12:00 pm - 12:30 pm

Place of Service: Patient was located at their home at 123 Main St Anywhere US 12345 

Provider was located at their office: 456 Storybook Ln Hollywood CA 96852 

Session Details:

This session was provided via a HIPAA compliant interactive audio/video platform. The patient consented to this telemedicine encounter.

Subjective

Chief Complaint: Follow-up consultation with a 72-year-old African American retiree experiencing emotional distress related to the recent loss of her husband of 40 years.

HPI: Maria reports a mix of progress and setbacks in coping with her bereavement. She notes moments of relief, especially when surrounded by family, but still experiences waves of sadness triggered by memories. She denies suicidal ideation, reports a healthy appetite, and feels more focused overall.

ROS: No sleep disturbances, no headaches.

Current Medications: None

Objective

MSE:

• Appearance: Patient appears stated age, casually dressed.

• Behavior: Cooperative, makes fair eye contact.

• Mood: Depressed.

• Affect: Restricted.

• Speech: Normal rhythm, fluency, and tone; soft.

• Thought Process: Coherent, soft.

• Thought Content: Sadness, missing husband.

• Suicidality: Negative.

• Cognition: Alert and oriented x3. Recent memory poor; remote memory intact. Good fund of knowledge.

Exam: Unremarkable. Maria reaffirms her lack of suicidal ideation or intent.

Assessment

Diagnosis: Adjustment disorder with depressive symptoms F43.21

Plan

1. Referral to a grief therapist.

2. Continue monitoring her emotional progress.

3. No current medications required.

4. Follow-up as needed, based on patient preference.


Electronically signed by,

[Provider name, Credentials, Date signed]

_____________________________________________________________________________________________

Rationale information is not required in your note; it is provided for educational purposes only.    

Rationale and How the CPT Codes Were Selected (based on 2/3 elements):

Number and Complexity of Problems Addressed: 1 self-limited problem (bereavement).

Data Reviewed/Analyzed: None.

Risk of Complications and/or Morbidity: Minimal.

CPT Code Selected: 99212

Rationale: The client displays Low number & complexity of problems with one mild illness,      No data reviewed, and Minimal risk with no significant interventions required.

Level of MDM: Straightforward

CPT Codes Selected: 99212

CPT code 99212 reimbursement rates

Reimbursement rates for sessions billed with 99212 will vary depending on factors like the specific payer contract, your geographic location, and type of therapy license. Headway providers can check the portal for rates with each insurance provider.

Find out your rates with Headway

This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.

Billing and coding

How to use CPT code 99214

Code 99214 represents an existing patient appointment that’s at least 30 minutes in duration.

How to use CPT code 99214