Billing code 99215: Office visitMedicare rate & RVUs in Delaware
Highest-level established patient office or outpatient visit, reported for high medical decision making or at least 40 minutes of practitioner time on the encounter date.
Medicare pays $191.05 for 99215 in the office in Delaware (Delaware). Which amount applies depends on the service address.
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 9 sections
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.
99215 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $191.05 | $125.05 |
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.
How the rate is built · 99215
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.80Practice expense 2.75Malpractice 0.21
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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.
Place of service · 99215
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$192.39
The facility rate would be $125.59 (+$66.80). In a facility, the facility bills its own costs separately.
99215 compared with similar codes
Compare codes
99215 vs 99214 vs 99205 vs 99233 vs 99245: national Medicare rates
Swap in your local Medicare rate.
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.
99215 billing questions
What separates 99215 from 99214?
Code 99215 requires high medical decision making or at least 40 minutes of total time; 99214 requires moderate medical decision making or at least 30 minutes. High management risk alone is insufficient for high medical decision making: a second element must also reach the high level.
Which prolonged services code does Medicare accept with 99215?
Medicare uses HCPCS G2212 rather than billing code 99417. The first G2212 unit begins at 69 minutes of total practitioner time on the encounter date, with another unit for each additional 15 minutes.
Can G2211 be added to 99215?
Yes, when the visit reflects ongoing care as the focal point for a patient's health needs or ongoing care for a serious or complex condition. Medicare generally does not pay G2211 when 99215 carries modifier 25, but exceptions include certain preventive services and vaccine administration.
What time counts toward the 40 minutes?
Count the billing practitioner's eligible face-to-face and non-face-to-face work on the encounter date, including counseling, ordering, care coordination, and documentation. Exclude clinical staff time and time spent on separately reported services.
When is modifier 25 needed on 99215?
Append modifier 25 when a same-day procedure accompanies a significant, separately identifiable visit beyond the procedure's usual work. The note must support the distinct evaluation, such as management of a severe COPD exacerbation during an encounter that also includes a joint injection.
Does a decision to admit the patient support high medical decision making?
A documented decision about hospitalization can support high management risk. The note must also establish high problem complexity or extensive data analysis to meet the two-of-three requirement for high medical decision making.
99215 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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