CMS RVU26D · Effective 2026-10-01
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. Compare 99211 office and facility rates across CMS payment localities in Massachusetts.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
$25.37–$28.09
2 of 2 localities have a supported rate.
$7.78–$8.15
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Evaluation and management
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.
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.
1.3M
Medicare services in 2024 · #123 by national volume
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.
Office rates for Massachusetts, from the same CMS release.
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.
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.
Coll 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.
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.
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Office / nonfacility
$28.09
Facility
$8.15
Office / nonfacility
$25.37
Facility
$7.78
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Compare office and outpatient evaluation-and-management base rates.
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.
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.
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.
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.
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.
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
