Infectious Disease
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.
Top billed codes
The codes that drive revenue in this specialty. Click any code for documentation requirements, modifiers, and pitfalls.
| Code | Description | wRVU | Total RVU | Medicare $ | |
|---|---|---|---|---|---|
| 99204 | Office o/p new mod 45 min New patient with a moderately complex problem requiring comprehensive history, exam, and drug management. The default new-patient code in primary care and most subspecialties. | 2.60 | 5.31 | $177 | Details → |
| 99205 | Office o/p new hi 60 min New patient with severe, decompensated, or high-acuity disease. Complex consult-style new patient encounters. | 3.50 | 7.09 | $237 | Details → |
| 99214 | Office o/p est mod 30 min The workhorse code. Two or more chronic problems with progression/treatment changes, OR one undiagnosed new problem with uncertain prognosis, OR prescription drug management. | 1.92 | 4.06 | $136 | Details → |
| 99215 | Office o/p est hi 40 min Severe exacerbation, decompensated chronic illness, decision regarding hospitalization, or extensive comorbidity management requiring high-risk decision-making. | 2.80 | 5.76 | $192 | Details → |
| G2211 | Complex e/m visit add on Add-on to office E/M (99202-99215) when you are the continuing focal point for all needed care (primary care) OR the ongoing care provider for a single serious/complex condition. | 0.33 | 0.52 | $17 | Details → |
| 99417 | Prolng op e/m each 15 min Add-on when total time on date of encounter exceeds the threshold for 99205 (75 min) or 99215 (55 min). Each unit = 15 additional minutes. | 0.61 | 0.96 | $32 | Details → |
| 96365 | Therapeutic IV infusion first hour First therapeutic non-chemo IV infusion at the encounter. | 0.21 | 2.04 | $68 | Details → |
| 96366 | Therapeutic IV infusion ea addl hour Each additional hour of the same therapeutic infusion. | 0.18 | 0.68 | $23 | Details → |
| 96374 | IV push single substance Single IV push of a non-chemo drug. | 0.18 | 1.04 | $35 | Details → |
| G0316 | Prolonged hospital E/M ea 15 min Medicare-specific prolonged service code for outpatient E/M, replacing 99417 for Medicare beneficiaries. Each 15 minutes beyond 99215/99205 thresholds. | 0.61 | 0.83 | $28 | Details → |
Common visit scenarios
How the codes stack on real encounters. Each scenario is one billable approach, not the only one.
High-complexity new patient. 99417 = each additional 15 minutes when total time exceeds the 99205 threshold (75 min Medicare).
Once the infection is being managed in the outpatient setting, weekly OPAT review visits qualify for moderate complexity if labs and drug adjustments are documented.
Add 96366 for each additional hour. 96374 if IV push instead of infusion. Drug J-codes billed separately.
Modifier and bundling rules
- •G0316 is the Medicare prolonged outpatient service code that replaced 99417 for Medicare in 2023 — use the right one per payer.
- •Modifier 95 on telehealth E/M, with home POS (10) or other (02).
- •Travel medicine consultations are usually self-pay; check payer contracts.
Search the full library or jump straight to the calculator to model volumes.
Educational reference, not billing or legal advice. Coverage curated, not exhaustive. Verify against payer contracts.