99215
E/M EstCMS status: AOffice or other outpatient visit, established patient, high-level MDM or 40-54 minutes total time.
Work RVU
2.80
Practice RVU
2.75
Malpractice RVU
0.21
Total RVU
5.76
2026 Medicare payment
$192.39
National GPCI = 1.000 · Conversion factor $33.4009 · Non-facility
Model this code
Drop 99215 into a scenario to see how unit volume rolls up to annual wRVUs, gross collections, and bonus.
Open in calculator →When to use it
Severe exacerbation, decompensated chronic illness, decision regarding hospitalization, or extensive comorbidity management requiring high-risk decision-making.
Documentation checklist
- ✓MDM: high complexity — severe exacerbation, decision re: hospitalization, drug therapy requiring intensive monitoring.
- ✓Or 40-54 minutes total time on date of encounter, documented.
- ✓Document the high-risk element explicitly (e.g. 'considered admission').
Common pitfalls
- !Billing 99215 for a routine moderate-complexity patient.
- !Failing to document the decision-regarding-hospitalization or intensive-monitoring element.
Common modifiers
2595
Common ICD-10 pairings
I50.21E11.65J44.1I48.91
Pairs well with
Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.