Billing code 99215: Office visitMedicare rate & RVUs

Medicare pays $192.39 for 99215 nationally in the office and $125.59 in a hospital or facility. Local office rates run $176.04–$241.97.

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

What 99215 covers

This visit covers an established patient who needs a high-intensity office or outpatient evaluation. A patient with decompensated heart failure or a new problem that may threaten life or bodily function may have the problem complexity associated with this level, but the overall level depends on the medical decision making or time documented. Physicians, nurse practitioners, and physician assistants perform these visits in private offices, clinics, and hospital outpatient departments.

Select 99215 for high medical decision making or at least 40 minutes of the billing practitioner's total time on the encounter date. High medical decision making requires two of three elements: high problem complexity, extensive data analysis, and high management risk. Risk examples include a decision about hospitalization or drug treatment requiring intensive toxicity monitoring. Document the work supporting those elements, or record total time that includes eligible face-to-face and non-face-to-face work. When a same-day procedure also occurs, append modifier 25 to 99215 only if the visit is significant and separately identifiable from the procedure's usual work. For Medicare prolonged time beyond this visit, report G2212 when its threshold is met.

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 99215 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99215 rates by state

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

How the 99215 rate is calculated

Each of 99215’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 99215

99215 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.

99215 compared with similar codes

How to choose

99214Office visit

Choose 99215 for high medical decision making or at least 40 minutes. Moderate medical decision making or at least 30 minutes supports 99214 when the higher level is not met.

99205Office visit

Code 99205 is for a new patient with high medical decision making or at least 60 minutes. Check whether the patient received professional services from the billing physician or another qualified professional of the same specialty and subspecialty in the group within the past three years.

99233Hospital follow-up visit

Code 99233 is for a subsequent inpatient or observation encounter. An established patient visit in an office or hospital outpatient department is evaluated under 99215 instead.

99245Off/op consltj new/est hi 55

Code 99245 describes a requested office consultation for payers that recognize consultation codes. Medicare does not pay consultation codes; report 99215 for an established patient only when the visit meets its medical decision making or time criteria.

Codes related to 99215

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

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