Infectious Disease, coding reference.
Almost entirely cognitive. Revenue depends on accurate complexity coding (99214/99215 with G2211), outpatient infusion management, and prolonged service coding for long visits. Antimicrobial stewardship rounds are not billable.
Selected reference codes
A curated selection, not a utilization ranking. Open a code for documentation requirements, modifiers, and pitfalls.
| Code | Description | wRVU | Total RVU | Medicare $ | |
|---|---|---|---|---|---|
| 99204 | Office o/p new mod 45 min 99204 is the default code for most new-patient outpatient encounters in primary care and outpatient subspecialty practice. Use it for a new patient with at least one of: two or more chronic problems with progression or treatment changes; one undiagnosed new problem with uncertain prognosis; prescription drug management. Common patterns: new patient establishing primary care with multiple chronic comorbidities; new endocrinology consult for poorly controlled T2DM; new cardiology consult for chest pain and an abnormal stress test result. Prescription drug management satisfies moderate risk on its own, which makes 99204 the right code for the vast majority of new-patient continuity encounters. Time-based alternative is 45 to 59 minutes of total time on the date of the encounter. | 2.60 | 5.31 | 177 | Details → |
| 99205 | Office o/p new hi 60 min Select this level when at least two of the three MDM elements meet high complexity, or when qualifying total time reaches 60 minutes. A diagnosis, medication, or high-risk decision alone does not establish the overall level. For Medicare prolonged services with this time-selected base code, the first G2212 unit requires 89 minutes. Payers recognizing CPT 99417 use different thresholds. | 3.50 | 7.09 | 237 | Details → |
| 99214 | Office o/p est mod 30 min 99214 is the workhorse of primary care and most outpatient subspecialties. Use it when at least one of these is true: two or more chronic problems with progression, treatment changes, or side effects; one undiagnosed new problem with uncertain prognosis; one acute illness with systemic symptoms; or prescription drug management at any complexity. Prescription drug management on its own satisfies the moderate-risk element, which is why straightforward chronic disease follow-ups with a med adjustment routinely clear the 99214 bar. Time-based alternative is 30 to 39 minutes of total time on the date of the encounter. Pick the method that supports the strongest note: encounters with prescription changes are usually cleaner under MDM; encounters with extensive counseling or care coordination are usually cleaner under time. | 1.92 | 4.06 | 136 | Details → |
| 99215 | Office o/p est hi 40 min Select this level when at least two of the three MDM elements meet high complexity, or when qualifying total time reaches 40 minutes. A diagnosis, medication, or high-risk decision alone does not establish the overall level. For Medicare prolonged services with this time-selected base code, the first G2212 unit requires 69 minutes. Payers recognizing CPT 99417 use different thresholds. | 2.80 | 5.76 | 192 | Details → |
| G2211 | Complex e/m visit add on Consider the ongoing responsibility for the patient's care: either a continuing focal point for needed services or ongoing care of a serious or complex condition. It is not automatic for a diagnosis or specialty. | 0.33 | 0.52 | 17 | Details → |
| 99417 | Prolng op e/m each 15 min For a qualifying time-selected base service under the current CPT and payer rules. Office examples: the first unit with 99205 begins at 75 minutes; with 99215 at 55 minutes. Verify eligibility for other base services rather than extrapolating office thresholds. | 0.61 | 0.96 | See policy | Details → |
| 96365 | Ther/proph/diag iv inf init First therapeutic non-chemo IV infusion at the encounter. | 0.21 | 2.01 | 67 | Details → |
| 96366 | Ther/proph/diag iv inf addon Each additional hour of the same therapeutic infusion. | 0.18 | 0.64 | 21 | Details → |
| 96374 | Ther/proph/diag inj iv push Single IV push of a non-chemo drug. | 0.18 | 1.13 | 38 | Details → |
| G2212 | Prolong outpt/office vis Apply the Medicare time thresholds to a qualifying time-selected base service. | 0.61 | 1.02 | 34 | Details → |
Service-selection examples
Codes to investigate, including alternatives. A scenario does not establish that every listed service is separately billable.
For Medicare, a time-selected 99205 first qualifies for G2212 at 89 minutes. Other payers may recognize CPT 99417 with different thresholds. These are alternatives, not interchangeable add-ons.
Weekly frequency and drug adjustments do not by themselves establish moderate MDM. Document at least two qualifying MDM elements or the required E/M time.
Record start/stop times, route and substances. Check the infusion hierarchy and time thresholds before assigning an initial or additional-hour code.
Modifier and bundling checks
- •Modifier 25 applies only to a significant, separately identifiable E/M service; the presence of a procedure alone does not justify it.
- •Check current code-pair edits and modifier indicators. Modifier 59 or an X modifier does not make bundled or undocumented work separately payable.
- •Coverage, telehealth eligibility, frequency, components and cost sharing vary by payer and service date. Follow the linked sources and the actual payer policy.
Verify the individual services
These educational examples are not approved claim bundles. Listed codes may be alternatives. Check the actual service, current code-pair edits, payer coverage, timing and documentation before reporting.
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Educational reference, not billing or legal advice. Coverage curated, not exhaustive. Verify against payer contracts.