Billing code 99212: Office visitMedicare rate & RVUs in Guam
Established-patient office or outpatient evaluation selected by straightforward medical decision making or at least 10 minutes of physician or qualified professional time.
Medicare pays $63.28 for 99212 in the office in Guam (Hawaii, Guam). 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 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.
99212 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $63.28 | $31.00 |
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.
How the rate is built · 99212
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.70Practice expense 1.02Malpractice 0.06
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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.
Place of service · 99212
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$59.45
The facility rate would be $31.06 (+$28.39). In a facility, the facility bills its own costs separately.
99212 compared with similar codes
Compare codes
99212 vs 99211 vs 99213 vs 99202 vs 99242: national Medicare rates
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How to choose
- 99211Office visit
- 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 visit
- 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 visit
- 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.
- 99242Off/op consltj new/est sf 20
- 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.
99212 billing questions
When should 99212 be chosen instead of 99213?
Choose 99212 for straightforward decision making or at least 10 minutes of qualifying total time. Choose 99213 when the documented decision making is low complexity or qualifying total time reaches 20 minutes; one minor problem alone does not determine the decision-making level.
Can a nurse-only visit be billed as 99212?
No. 99212 requires an evaluation by a physician or qualified health professional. A qualifying brief established-patient service performed by clinical staff may be reported with 99211.
What counts toward the 10-minute time threshold?
Count the billing practitioner's qualifying work on the encounter date, whether face-to-face or not, such as reviewing records, ordering tests, and documenting. Exclude clinical staff time and time spent on separately reported services.
Is modifier 25 needed when 99212 is billed with a procedure?
Append modifier 25 to 99212 when a same-day minor procedure is performed only if the documentation supports a significant, separately identifiable E/M service beyond the procedure's usual assessment and care. The usual decision to perform the minor procedure does not by itself support a separate visit.
Can G2211 be added to a 99212 visit?
G2211 may be reported with 99212 when the practitioner serves as the continuing focal point for the patient's care or provides ongoing care for a single serious or complex condition. A one-time visit for a minor problem with no longitudinal relationship does not support it.
99212 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
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