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.
When to use it
Use 99211 for established-patient encounters where clinical staff (RN, LPN, MA) provide the service under the billing provider's general supervision. Common scenarios: blood pressure check with documentation, INR check and warfarin dose adjustment per protocol, B12 injection administration, allergy shot observation period, simple suture or staple removal, post-vaccination 15-minute observation, depot injection follow-up.
Full guidance
99211 cannot be billed when the encounter is purely administrative (refill calls, scheduling, paperwork) or when no clinical service occurred. Time-of-service documentation by the clinical staff is essential.
Documentation checklist
- ✓Reason for the encounter (BP recheck, INR, injection, etc.).
- ✓Clinical staff observations or service performed.
- ✓Vital signs if obtained.
- ✓Physician or QHP general supervision documented. "Physician available in the office and immediately accessible" satisfies general supervision; physical presence is not required.
- ✓Any action taken or communication with the billing provider (dose change, callback, decision).
- ✓Clinical staff signature and date.
Common pitfalls
- !Billed without any clinical service occurring. "Patient called for refill" or "medical record reviewed" alone do not justify 99211.
- !Used as a placeholder for a non-billable contact. CMS audits the supervision and service-content requirements.
- !Forgetting that an injection visit cannot bill 99211 plus the injection administration code (96372 or 90471) when the staff time is used to satisfy 99211 — the time is double-counted. Pick one.
- !Billing 99211 for a visit that actually had physician face-to-face involvement. If you saw the patient, the appropriate code is 99212 or higher.
- !Same-day 99211 plus a problem-oriented E/M by the same physician — bundles unless separately identifiable with modifier 25.
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.