Code 99212 represents an existing patient appointment that’s at least 10 minutes in duration.
December 9, 2024
11 min read
The 99212 code is an E/M code used by prescribing providers. For other E/M codes, visit this overview.
Code 99212 represents an existing patient appointment that’s at least 10 minutes in duration. It’s a prescriber code, which means it’s most commonly used by psychiatrists or nurse practitioners.
This is is how the American Medical Association defines 99212 in the official CPT codebook:
CPT code 99212: Existing patient office visit, minimum 10 minutes
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
As a prescriber, you can bill insurance according to time or medical decision-making (MDM). Make sure to include sufficient documentation to support the method you choose.
If you spent 15 minutes with a client but the case was especially complex or high risk, or involved reviewing or analyzing a lot of data, you may use a higher CPT code, including 99213 (low MDM), 99214 (moderate MDM), or 99215 (high MDM).
It’s important to use the code that most accurately reflects the time you spent with the patient to treat their condition, and ensure that documentation for the session supports the chosen code.
Simplify insurance and save time on your entire workflow — from compliance and billing to credentialing and admin.
If you’re treating a new patient, you should use 99202 instead. A new patient is someone you have not seen in the last three years.
Documentation for 99212 is essentially the same as other E/M codes, but geared toward a new patient. New patient notes should always include:
In the example note below, the following factors are present, making 99212 the best code for billing the session:
Patient Name: Maria Johnson
Patient DOB: 01/15/1952
Date of Service: 09/21/2024
Appointment Time: 12:00 pm - 12:30 pm
Place of Service: Patient was located at their home at 123 Main St Anywhere US 12345
Provider was located at their office: 456 Storybook Ln Hollywood CA 96852
Session Details:
This session was provided via a HIPAA compliant interactive audio/video platform. The patient consented to this telemedicine encounter.
Chief Complaint: Follow-up consultation with a 72-year-old African American retiree experiencing emotional distress related to the recent loss of her husband of 40 years.
HPI: Maria reports a mix of progress and setbacks in coping with her bereavement. She notes moments of relief, especially when surrounded by family, but still experiences waves of sadness triggered by memories. She denies suicidal ideation, reports a healthy appetite, and feels more focused overall.
ROS: No sleep disturbances, no headaches.
Current Medications: None
MSE:
• Appearance: Patient appears stated age, casually dressed.
• Behavior: Cooperative, makes fair eye contact.
• Mood: Depressed.
• Affect: Restricted.
• Speech: Normal rhythm, fluency, and tone; soft.
• Thought Process: Coherent, soft.
• Thought Content: Sadness, missing husband.
• Suicidality: Negative.
• Cognition: Alert and oriented x3. Recent memory poor; remote memory intact. Good fund of knowledge.
Exam: Unremarkable. Maria reaffirms her lack of suicidal ideation or intent.
Diagnosis: Adjustment disorder with depressive symptoms F43.21
1. Referral to a grief therapist.
2. Continue monitoring her emotional progress.
3. No current medications required.
4. Follow-up as needed, based on patient preference.
Electronically signed by,
[Provider name, Credentials, Date signed]
_____________________________________________________________________________________________
Rationale information is not required in your note; it is provided for educational purposes only.
Number and Complexity of Problems Addressed: 1 self-limited problem (bereavement).
Data Reviewed/Analyzed: None.
Risk of Complications and/or Morbidity: Minimal.
CPT Code Selected: 99212
Rationale: The client displays Low number & complexity of problems with one mild illness, No data reviewed, and Minimal risk with no significant interventions required.
Level of MDM: Straightforward
CPT Codes Selected: 99212
Reimbursement rates for sessions billed with 99212 will vary depending on factors like the specific payer contract, your geographic location, and type of therapy license. Headway providers can check the portal for rates with each insurance provider.
This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.
Simplify insurance and save time on your entire workflow — from compliance and billing to credentialing and admin.
This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.
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Understand the ins and outs of CPT codes to help make documentation and billing more efficient — and give you more time to focus on other areas of your practice.
Headway strives to simplify billing insurance so you can focus on providing care. Read our comprehensive guide to mental health billing.
Understand the ins and outs of CPT codes to help make documentation and billing more efficient — and give you more time to focus on other areas of your practice.
