CPT code 99211: Office visit, established patient, minimal E/M2026 Medicare rate & RVUs in Virginia

In Virginia, Medicare pays $23.98 for 99211 in the office and $7.56 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 99211 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99211 covers

This is the lowest-level established-patient office or outpatient E/M visit. A physician or other qualified health care professional may not need to be present for the encounter. An RN, LPN, or medical assistant may recheck blood pressure against an existing treatment plan or teach a patient how to use a prescribed device. A physician or qualified practitioner may also perform a visit at this level. The encounter must involve a medically necessary evaluation or management service, rather than a measurement taken solely as part of another service.

Select 99211 without using the medical decision-making levels or minimum practitioner times used for 99212 through 99215. Document the reason for the encounter, relevant findings, assessment or instructions, and, for a staff visit, its connection to the treating practitioner's plan. For Medicare office billing of clinical-staff services incident to a practitioner’s work, the practitioner must have initiated treatment and provide required direct supervision, including being present in the office suite and immediately available. If the encounter consists only of an injection or specimen draw, report the applicable procedure rather than an additional 99211.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Virginia compares for 99211

Across 109 of 109 payment localities, the office rate for 99211 runs from $21.68 in Arkansas to $32.86 in San Benito County, CA. Virginia pays $23.98. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99211 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 99211 in every payment locality

How the 99211 rate is calculated

Each of 99211’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 99211

99211 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate. Billing it with a same-day procedure? See modifier 25.

99211 compared with similar codes

Same family in Virginia

How to choose

99212Office visitEstablished patient, straightforward

99212 requires a physician or qualified practitioner's E/M service supported by straightforward MDM or at least 10 minutes of practitioner time. Clinical staff can provide a qualifying 99211 service under applicable supervision requirements.

96372SC/IM injectionTherapeutic, prophylactic, or diagnostic

If the encounter consists only of a therapeutic injection, report the administration service, not 99211. A distinct, medically necessary E/M service must be documented to consider reporting 99211 as well.

36415VenipunctureRoutine venous sample

Report a visit solely for routine venipuncture with the applicable collection code. Do not add 99211 merely because the patient came to the office for a blood draw.

99202New patient visitStraightforward MDM or 15 minutes

99202 is a practitioner E/M visit for a new patient, selected by straightforward MDM or at least 15 minutes of practitioner time. 99211 is limited to established patients and may be performed by clinical staff.

Codes related to 99211

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 99211 has changed in Virginia

Price 99211 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

• Abbs Valley
• Abingdon
• Accomac
• Adwolf
• Afton
• Alberta
• Aldie
• Allison Gap

Browse all communities in Virginia

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates