$126.27–$132.41
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.
On this page
CMS RVU26D · Effective 2026-10-01
99215 Office visit Medicare reimbursement rates in Missouri
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. Compare 99215 office and facility rates across CMS payment localities in Missouri.
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.
What does Medicare pay for 99215 in Missouri?
Missouri has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
$179.53–$187.99
3 of 3 localities have a supported rate.
Facility setting
$121.95–$124.40
3 of 3 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.
Where 99215 pays more and less in Missouri
3 payment localities
$179.53 to $187.99
Evaluation and management
About 99215: Established patient office visit, high complexity
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.
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.
Where the value comes from
- Work RVU2.80 · 49%
- Practice expense (office) RVU2.75 · 48%
- Malpractice RVU0.21 · 4%
12.9M
Medicare services in 2024 · #14 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.
99215 compared with similar codes
Office rates for Missouri, from the same CMS release.
$221.61–$231.66
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.
No office rate
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.
99245
No office rateOff/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.
Compare 99215 by payment locality
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.
3 of 3 payment localities
Metropolitan Kansas City →
Office / nonfacility
$186.62
Facility
$123.90
Metropolitan St. Louis →
Office / nonfacility
$187.99
Facility
$124.40
Rest Of Missouri →
Office / nonfacility
$179.53
Facility
$121.95
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Primary care
Compare office and outpatient evaluation-and-management base rates.
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 CPT 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.
Where these rates come from
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.
13,01499212,,Office o/p est sf 10 min,A,,0.70,1.02,,0.17,,0.06,1.78,0.93,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01599213,,Office o/p est low 20 min,A,,1.30,1.46,,0.33,,0.09,2.85,1.72,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01699214,,Office o/p est mod 30 min,A,,1.92,2.00,,0.47,,0.14,4.06,2.53,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01799215,,Office o/p est hi 40 min,A,,2.80,2.75,,0.75,,0.21,5.76,3.76,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01899221,,1st hosp ip/obs sf/low 40,A,,1.63,0.41,NA,0.41,,0.19,2.23,2.23,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01999222,,1st hosp ip/obs moderate 55,A,,2.60,0.67,NA,0.67,,0.23,3.50,3.50,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,02099223,,1st hosp ip/obs high 75,A,,3.50,0.90,NA,0.90,,0.28,4.68,4.68,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00