Billing code 99211: Office visitMedicare rate & RVUs
Report a minimal office or outpatient E/M visit for an established patient when a distinct service is provided, often by clinical staff under supervision.
Medicare pays $24.38 for 99211 nationally in the office and $7.68 in a hospital or facility. Local office rates run $21.68–$32.86.
Medicare rate · 99211
Office visit
Swap in your local Medicare rate.
- Work RVUs
- 0.18
- Total RVUs
- 0.73
- Global days
- XXX
National rate · 2026
$24.38
Office setting, before claim adjustments.
See every locality for 99211 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
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.
Where 99211 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$21.68 to $32.86
109 of 109 payment localities
99211 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$21.68
$29.46
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $28.41 | 1 |
| AL | $21.98 | 1 |
| AR | $21.68 | 1 |
| AZ | $23.78 | 1 |
| CA | $26.06–$32.86 | 29 |
| CO | $25.54 | 1 |
| CT | $25.96 | 1 |
| DC | $27.96 | 1 |
| DE | $24.16 | 1 |
| FL | $23.76–$25.63 | 3 |
| GA | $22.50–$24.76 | 2 |
| GU | $26.71 | 1 |
| HI | $26.71 | 1 |
| IA | $22.65 | 1 |
| ID | $22.76 | 1 |
| IL | $23.00–$25.17 | 4 |
| IN | $22.89 | 1 |
| KS | $22.49 | 1 |
| KY | $22.35 | 1 |
| LA | $22.29–$23.36 | 2 |
| MA | $25.37–$28.09 | 2 |
| MD | $24.63–$27.96 | 3 |
| ME | $22.81–$24.10 | 2 |
| MI | $22.86–$23.98 | 2 |
| MN | $24.67 | 1 |
| MO | $21.88–$23.52 | 3 |
| MS | $21.79 | 1 |
| MT | $24.38 | 1 |
| NC | $23.05 | 1 |
| ND | $24.18 | 1 |
| NE | $22.79 | 1 |
| NH | $25.08 | 1 |
| NJ | $26.31–$27.67 | 2 |
| NM | $22.95 | 1 |
| NV | $24.34 | 1 |
| NY | $23.38–$28.46 | 5 |
| OH | $22.82 | 1 |
| OK | $22.38 | 1 |
| OR | $24.21–$26.40 | 2 |
| PA | $22.89–$25.29 | 2 |
| PR | $24.58 | 1 |
| RI | $25.06 | 1 |
| SC | $22.96 | 1 |
| SD | $24.16 | 1 |
| TN | $22.59 | 1 |
| TX | $22.74–$25.40 | 8 |
| UT | $23.27 | 1 |
| VA | $23.98–$27.96 | 2 |
| VI | $24.58 | 1 |
| VT | $24.04 | 1 |
| WA | $25.34–$28.72 | 2 |
| WI | $23.39 | 1 |
| WV | $22.16 | 1 |
| WY | $24.30 | 1 |
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.
How the rate is built · 99211
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.18Practice expense 0.54Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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.
Place of service · 99211
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$24.38
The facility rate would be $7.68 (+$16.70). In a facility, the facility bills its own costs separately.
99211 compared with similar codes
Compare codes
99211 vs 99212 vs 96372 vs 36415 vs 99202: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 99212Office visit
- 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 injection
- 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.
- 36415Coll venous bld venipuncture
- 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 visit
- 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.
99211 billing questions
Can a new patient visit be reported with 99211?
No. 99211 is limited to established patients. New-patient status generally means the patient has not received professional services from the physician or qualified practitioner, or another of the same specialty and subspecialty in the group, within the past three years.
Should 99211 be billed when a nurse only gives an injection?
No. If the encounter consists solely of a therapeutic injection, report the applicable administration code, such as 96372, and a drug code when separately reportable. The injection alone does not support an additional 99211.
Does 99211 use medical decision making or time for level selection?
No. Unlike 99212 through 99215, 99211 has no medical decision-making level or minimum practitioner time requirement. Document the distinct, medically necessary E/M service.
What documentation supports a clinical-staff visit under 99211?
Record the reason for the visit, relevant measurements or findings, assessment or instructions, and how the service relates to the treating practitioner's plan. Identify the staff member and supervising practitioner, and document any practitioner communication that occurred.
Can a physician report 99211 for their own visit?
Yes. A physician or qualified health care professional may personally provide the service. Select 99212 or higher only when the documented medical decision making or practitioner time supports that level.
99211 is in these specialty bundles: Primary care
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
Show the CMS file lines behind this rate
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