CPT code 99212: Office visit, established patient, straightforward2026 Medicare rate & RVUs in Puerto Rico

In Puerto Rico, Medicare pays $59.80 for 99212 in the office and $31.10 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 99212 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 99212 covers

This is the lowest office visit level requiring a physician or qualified health professional's evaluation of an established patient. Established status generally means the patient received a professional service within the past three years from the same practitioner or a same-specialty practitioner in the group. Straightforward decision making may involve one self-limited or minor problem, minimal or no data review, and minimal management risk; the documented decision-making elements determine the level. Physicians, nurse practitioners, and physician assistants report these visits in offices, clinics, and hospital outpatient departments. History and examination are documented as medically appropriate but do not determine the level.

Select 99212 by straightforward medical decision making or by at least 10 minutes of the billing practitioner's total time on the encounter date, including qualifying chart review and documentation that day. Document the decision-making elements or, when selecting by time, the total minutes. CMS assigns lower practice expense relative value units in a facility than in an office because facility overhead is accounted for outside the professional claim. If a minor procedure occurs on the same day, report 99212 with modifier 25 only for a significant, separately identifiable E/M service beyond the procedure's usual assessment and care.

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 Puerto Rico compares for 99212

Across 109 of 109 payment localities, the office rate for 99212 runs from $53.68 in Arkansas to $76.15 in San Benito County, CA. Puerto Rico pays $59.80. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99212 rates by state

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

See 99212 in every payment locality

How the 99212 rate is calculated

Each of 99212’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 99212

99212 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.

99212 compared with similar codes

Same family in Puerto Rico

How to choose

99211Office visitEstablished patient, minimal E/M

99211 may cover a qualifying established-patient service performed by clinical staff without a face-to-face practitioner evaluation. 99212 requires the practitioner's evaluation, supported by straightforward decision making or at least 10 minutes.

99213Office visitEstablished patient, low complexity

99213 is supported by low-complexity decision making or at least 20 minutes of qualifying total time. When selecting by decision making, straightforward complexity supports 99212 even if total time is below 20 minutes.

99202New patient visitStraightforward MDM or 15 minutes

99202 is the straightforward level for new patients. Use 99212 when the patient meets the established-patient definition based on professional services received within the past three years.

99242Office consultationStraightforward level

99242 describes a qualifying requested office consultation for a payer that recognizes consultation codes. Medicare does not pay consultation codes; select the appropriate office or outpatient visit code, including 99212 when its established-patient criteria are met.

Codes related to 99212

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

How 99212 has changed in Puerto Rico

Price 99212 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

• Aceitunas
• Adjuntas
• Aguada
• Aguadilla
• Aguas Buenas
• Aguas Claras
• Aguilita
• Aibonito

Browse all communities in Puerto Rico

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