99212
Office o/p est sf 10 min
Office or other outpatient visit, established patient, straightforward medical decision making OR 10 to 19 minutes of total time on the date of the encounter. CMS 2026 wRVU 0.70. Reserved for truly minor, single-problem encounters; most established-patient encounters meet 99213 or 99214 criteria.
When to use it
Use 99212 for an established patient with one stable, minor problem requiring simple management. Common patterns: a brief follow-up for a fully resolved acute illness, a single uncomplicated medication refill encounter with stable labs, a minor dermatologic complaint with no decision required, a one-issue post-op check.
Full guidance
Time-based alternative is 10 to 19 minutes of total time on the date of the encounter. In primary care, 99212 is uncommon at the encounter level because most established follow-ups involve at least limited data review or low-complexity MDM (meeting 99213).
Documentation checklist
- ✓MDM straightforward: one self-limited or minor problem, minimal or no data review, minimal risk.
- ✓Time alternative: 10 to 19 minutes of total physician or QHP time on date of encounter.
- ✓Brief HPI focused on the problem at hand, an exam relevant to that problem, and a clear plan.
- ✓Pick one method (time or MDM) per encounter.
Common pitfalls
- !Routinely UNDER-coded. The most common 99212 mistake is using it for a visit that actually had limited data review (lab review, external records, independent historian), prescription management, or moderate-risk decisions; that's a 99213 (low MDM) or 99214 (moderate MDM with prescription management).
- !Prescription refill of a chronic medication usually meets 99213 (low MDM) at minimum because prescription decision-making clears the low-complexity bar.
- !Billing 99212 when the encounter actually had elements of stable chronic condition follow-up with med review. Almost always 99213 territory.
- !Time-based 99212 with vague time documentation. Audit-proof requires total time AND qualifying activities listed.
Payer notes
Medicare and commercial payers cover 99212 routinely. The 99213-to-99212 ratio is sometimes audited; clinicians with high 99212 rates relative to peers may be flagged for under-coding (rare audit pattern, but real). Most clinicians find that careful 2021-guideline-aligned coding moves many 99212 encounters to 99213.