99211
Off/op est may x req phy/qhp
Office or other outpatient visit, established patient, for the evaluation and management of a problem that may not require physician or QHP presence. CMS 2026 wRVU 0.18. The lowest-level E/M code, sometimes called the "nurse visit" code; billed for clinical-staff-only encounters supervised by the billing provider.
Billing guidance for 99211 is locked
- When to use it: the exact clinical situations that support billing 99211
- Documentation checklist: the 6 elements your note needs before submitting
- Common pitfalls: the 5 mistakes that get 99211 downcoded or denied
Payer notes
Medicare and commercial payers cover 99211 routinely when clinical-staff service is documented under physician general supervision (incident-to billing). Practice ownership matters: 99211 incident-to requires that the supervising physician be in the office suite (not just in the building). Many commercial plans cover BP checks, anticoagulation monitoring, and immunization observation under 99211; verify each payer for INR-monitoring specific codes.