Evaluation & management · General
Office or outpatient visit for an established patient with straightforward medical decision making, or at least 10 minutes of total time on the date of service.
- Medicare
- $59.45
- Work RVU
- 0.7
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Reason for the visit and interval history
- Focused exam of the affected area
- Assessment and plan with straightforward MDM, or total time
- If in a global period, a clear statement the problem is unrelated to the surgery
- If a procedure was done, separate documentation of the E/M work
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
99212 is a short established patient visit with straightforward decision making. In orthopedics it fits a stable, self-limited issue like a wound check outside a global period, a brace fit question, or a follow-up where nothing changes and no tests are reviewed.
The most common mistake is billing 99212 for a postop visit. Visits during a 90-day or 10-day global for the same surgery are included in the surgical payment and should go out as 99024 with no charge. Only bill 99212 in a global if the visit is for an unrelated problem, and add modifier 24.
When 99212 is billed with a same-day procedure such as an injection or splint, modifier 25 is needed and the note must show work beyond the usual pre-procedure check. Payers look at 99212 with 25 on injection days closely, because the separate work is often thin.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (0.7) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (1.78) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.7 |
| Practice expense RVU | 1.02 |
| Malpractice RVU | 0.06 |
| Total RVU | 1.78 |
| Medicare national rate | $59.45 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $59.45 |
Common denial reasons
The recurring reasons claims for CPT 99212 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Billed during a surgical global period without modifier 24
- Billed with an injection without modifier 25
- Modifier 25 used but the note shows only the pre-procedure assessment
- Diagnosis matches the surgery that is still in its global period
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01What is the time for CPT 99212?
02Can 99212 be billed during a 90-day global?
03Does 99212 with a steroid injection need modifier 25?
04What makes a visit straightforward MDM?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe keeps the visit's separate problems distinct in the note, which helps support modifier 24 or 25 when 99212 is billed alongside surgery or a procedure.
See how Mira captures CPT 99212 documentation