CMS RVU26D · Effective 2026-10-01
Established-patient office or outpatient evaluation selected by straightforward medical decision making or at least 10 minutes of physician or qualified professional time. Compare 99212 office and facility rates across CMS payment localities in Vermont.
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.
Vermont has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
$58.12
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
$30.02
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
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
Established-patient office or outpatient evaluation selected by straightforward medical decision making or at least 10 minutes of physician or qualified professional time.
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.
6.8M
Medicare services in 2024 · #32 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 Vermont, from the same CMS release.
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.
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.
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.
Off/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.
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.
1 of 1 payment localities
Office / nonfacility
$58.12
Facility
$30.02
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Compare office and outpatient evaluation-and-management base rates.
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 99212 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
13,014
GPCI2026.csv
105
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.70 | × 1.000 | 0.7000 |
| Practice expense | 1.02 | × 0.990 | 1.0098 |
| Malpractice | 0.06 | × 0.506 | 0.0304 |
| Total RVUs | 1.7402 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$58.12
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.7 | 1 |
| Practice expense | 1.02 | 0.99 |
| Malpractice | 0.06 | 0.506 |
(0.7 × 1 + 1.02 × 0.99 + 0.06 × 0.506) × $33.4009 = $58.12
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.7 | 1 |
| Practice expense | 0.17 | 0.99 |
| Malpractice | 0.06 | 0.506 |
(0.7 × 1 + 0.17 × 0.99 + 0.06 × 0.506) × $33.4009 = $30.02
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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.
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.
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.
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.
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.
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.
