National (GPCI 1.000)
$176.04–$241.97 across payment localities
Last change · 9.5% increase · Q1 2026National (GPCI 1.000)
$118.65–$170.83 across payment localities
Last change · 9.5% decrease · Q1 2026Participating physician · Before sequestration
Compare all payment localitiesFind the locality-adjusted allowed amount
CMS evidence · Q4 2026 release
( Work2.80 × 1.000 + Practice exp.2.75 × 1.000 + Malpractice0.21 × 1.000 ) × Conv. factor$33.4009 = $192.39
F Work RVU
2.80
G Non‑facility PE RVU
2.75
K MP RVU
0.21
Z Conversion factor
33.4009
( Work2.80 × 1.000 + Practice exp.0.75 × 1.000 + Malpractice0.21 × 1.000 ) × Conv. factor$33.4009 = $125.59
F Work RVU
2.80
I Facility PE RVU
0.75
K MP RVU
0.21
Z Conversion factor
33.4009
-
Physician relative value file (PPRRVU) · PPRRVU2026_Oct_nonQPP.csv row 13,017 in rvu26d-updated-08-26-2026.zip Download from CMS
Loading rows 13,015–13,019 of PPRRVU2026_Oct_nonQPP.csv…
-
Physician relative value file (PPRRVU) · PPRRVU2026_Oct_nonQPP.csv row 13,017 in rvu26d-updated-08-26-2026.zip Download from CMS
Loading rows 13,015–13,019 of PPRRVU2026_Oct_nonQPP.csv…
Nationally priced under PFS, using the RVU formula.
CMS RVU26DOctober 1 – December 31, 2026revision 2
The national PFS baseline is $192.39 for CPT 99215 in the Office (non-facility) setting and $125.59 in a facility under the Q4 2026 Physician Fee Schedule, effective October 2026. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded.
Why are the facility and non-facility amounts different?
Only the practice-expense RVU changes with the setting. For 99215 it's 2.75 RVUs in the Office (non-facility) setting versus 0.75 in a facility—the whole $66.80 gap between $192.39 and $125.59. In the Office (non-facility) setting the practice bears the overhead, so the allowed amount is higher; in a hospital or ASC the facility bills its own fee, so the professional amount is lower. See facility vs non-facility.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov).
About this code
Also known as Established patient office visit
A long return visit for someone with several active or serious problems to work through at once. Medicare reported 12.9 million services under this code in CY2024.
Plain-language context only—not the official CPT descriptor and not coding guidance
What could change this amount? Copy link
Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.
Service location and setting · Participation and payment shares
Other payment indicators (7)
Why would a Medicare claim for 99215 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- 379 codes form NCCI pairs with 99215 carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
- 6014 codes pair with 99215 under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together
- More than 1 unit per patient per date of service exceeds 99215's Medically Unlikely Edit (MUE) limit. See billing together
- Bilateral surgery: no bilateral adjustment. See billing policy
- Assistant at surgery: restricted without documentation. See billing policy
- Co-surgeons: not permitted. See billing policy
- Team surgery: not permitted. See billing policy
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
What do commercial payers pay for 99215? Copy link
Negotiated rates for 99215 vs Medicare Copy link
Commercial payers' negotiated rates for 99215 have medians of 57% to 209% of Medicare, depending on specialty and group size. For 4 of these, groups under 100 clinicians and larger groups are paid on different schedules, so both are shown.
Insurers must publish the rates they negotiate with in-network clinicians (the Transparency in Coverage rule). We reduce each file to medians by county and specialty and set them against Medicare's amount for the same place. Specialties that rarely or never perform a service are left out: contracts list a rate for nearly every code, including ones the group never bills.
| Specialty | Median rate | % of Medicare | Chart: median and middle half against Medicare |
|---|---|---|---|
|
BCBSIL PPO · Cook County, IL Every code in this file →Rate file of October 2026 · Medicare $202.59, the PFS Q4 2026 office (non-facility) amount in this county's payment locality |
|||
|
Internal Medicine 3,000 providers · 1,050 groups |
$209.62 52% paid exactly this | 103% middle half 103–170% | |
|
Family Medicine 1,823 providers · 840 groups |
$209.62 63% paid exactly this | 103% middle half 103–107% | |
|
General Surgery 761 providers · 253 groups |
$209.62 51% paid exactly this | 103% middle half 103–170% | |
| Showing 3 of 26 specialties published here. Below our publication rule: Pediatrics. | |||
|
Empire BCBS PPO/EPO · New York County, NY Every code in this file →Rate file of November 2026 · Medicare $217.37, the PFS Q4 2026 office (non-facility) amount in this county's payment locality |
|||
| Internal Medicine 2,062 providers · two pay schedules: groups under 100 clinicians and larger groups are paid differently | |||
|
Under 100 clinicians 692 providers · 704 groups |
$124.95 | 57% middle half 57–104% | |
|
100+ clinicians 1,652 providers · 118 groups |
$372.31 | 171% middle half 159–209% | |
| Pediatrics 1,265 providers · two pay schedules: groups under 100 clinicians and larger groups are paid differently | |||
|
Under 100 clinicians 342 providers · 285 groups |
$124.95 | 57% middle half 57–103% | |
|
100+ clinicians 1,099 providers · 96 groups |
$383.16 | 176% middle half 125–208% | |
| Hematology/Oncology 718 providers · two pay schedules: groups under 100 clinicians and larger groups are paid differently | |||
|
Under 100 clinicians 139 providers · 93 groups |
$124.95 | 57% middle half 57–159% | |
|
100+ clinicians 683 providers · 65 groups |
$455.12 | 209% middle half 171–333% | |
| Showing 3 of 27 specialties published here. | |||
|
BCBSTX Blue Choice PPO · Harris County, TX Every code in this file →Rate file of October 2026 · Medicare $195.13, the PFS Q4 2026 office (non-facility) amount in this county's payment locality |
|||
|
Internal Medicine 1,984 providers · 720 groups |
$159.78 69% paid exactly this | 82% | |
|
Family Medicine 1,312 providers · 785 groups |
$148.96 72% paid exactly this | 76% middle half 76–79% | |
|
General Surgery 767 providers · 256 groups |
$266.89 | 137% middle half 106–185% | |
| Showing 3 of 22 specialties published here. Below our publication rule: Cardiology, Hematology/Oncology, Neurology/Psychiatry, Pediatrics and Pulmonology. | |||
|
UnitedHealthcare Choice Plus · Los Angeles County, CA Every code in this file →Rate file of October 2026 · Medicare $210.68, the PFS Q4 2026 office (non-facility) amount in this county's payment locality |
|||
|
Internal Medicine 1,574 providers · 592 groups |
$258.78 | 123% middle half 59–179% | |
|
Family Medicine 1,139 providers · 495 groups |
$231.93 | 110% middle half 55–141% | |
| Pediatrics 881 providers · two pay schedules: groups under 100 clinicians and larger groups are paid differently | |||
|
Under 100 clinicians 489 providers · 270 groups |
$143.85 | 68% middle half 55–141% | |
|
100+ clinicians 434 providers · 29 groups |
$408.13 | 194% middle half 123–199% | |
| Showing 3 of 24 specialties published here. Below our publication rule: Hematology/Oncology, Neurology/Psychiatry and Psychiatry. | |||
How does your contract compare? Enter your % of Medicare
Payers publish this data, and each dataset carries its month. A negotiated rate describes the contract, not the payment, and networks and plan designs vary. We publish a benchmark only when at least 10 providers from at least 5 separately contracting groups stand behind it (tax IDs that contract together, like a health system's, count as one group), and no single group accounts for more than 25% of it. Browse all payer benchmarks →
Contracted rate: % of Medicare Copy link
Commercial contracts are often written as a percentage of Medicare ("115% of Medicare"). Enter yours to see what it means for 99215. A contract benchmarked to the fee schedule applies it to your locality's allowed amount, not the $192.39 national baseline; the calculator finds that amount from your service ZIP.
How location and RVUs set the amount Copy link
Rates by locality Copy link
The national baseline uses GPCI 1.000. These locality-adjusted allowed amounts use each payment locality's own GPCIs. Select a state to see its localities.
99215 Office (non-facility) rate by metro area
Highest amount first. Each figure is that payment locality's own GPCI-adjusted allowed amount.
Show 55 more metros Show fewer metros
99215 facility rate by metro area
Highest amount first. Each figure is that payment locality's own GPCI-adjusted allowed amount.
Show 55 more metros Show fewer metros
Q4 2026 amounts, computed with each locality's own GPCIs, before the ~2% sequestration cut. A state with more than one payment locality shows a range—its tile is colored by the mean across those localities, which is a shading choice, not an amount anyone is paid.
How this amount is computed Copy link
CPT 99215 has a work RVU of 2.80, a non-facility practice expense RVU of 2.75, a facility practice expense RVU of 0.75 and a malpractice RVU of 0.21—for total non-facility RVUs of 5.76 and total facility RVUs of 3.76 in the Q4 2026 release.
The formula is: (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.
| Component | RVU |
|---|---|
| Work RVU | 2.80 |
| Practice expense RVU (non-facility) | 2.75 |
| Practice expense RVU (facility) | 0.75 |
| Malpractice RVU | 0.21 |
Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead—higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, never as zero.
CMS RVU26DOctober 1 – December 31, 2026revision 2 See file rows
Allowed amount, Medicare's share, and patient share Copy link
These figures use the same national baseline, with different participation and payment assumptions.
Computed from the Q4 2026 CMS release
- Allowed amount
- $192.39
- Medicare's share
- $153.91
- Sequestration
- -$3.08
- What Medicare pays
- $150.83
- Patient coinsurance
- $38.48
- Non-participating amount
- $182.77
- Limiting charge
- $210.19
The fee-schedule amount for 99215 in the Office (non-facility) setting. A participating provider accepts it as payment in full, and every figure below starts from it.
80% of the allowed amount, once the annual Part B deductible is met.
The 2% cut to Medicare’s share. It never reduces the allowed amount or the patient’s coinsurance.
Medicare’s share after sequestration.
The remaining 20%. Medigap or Medicaid often covers it.
What a provider who doesn’t participate in Medicare is allowed on an assigned claim: 95% of the allowed amount.
The most a non-participating provider can bill the patient on an unassigned claim: 115% of the non-participating amount.
National Q4 2026 figures at GPCI 1.000. Adjust for your locality and sequestration, or open the explanations below for each figure in full.
Is $192.39 what a practice actually receives?
It's the national allowed amount—the starting point. Medicare pays 80% of it ($153.91) and the patient owes 20% coinsurance ($38.48). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. That payment is practice revenue that covers staff, space, equipment, and billing. It isn't the clinician's take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.
Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).
What's the non-participating amount for 99215?
$182.77 in the Office (non-facility) setting—95% of the $192.39 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.
Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.
What's the limiting charge for 99215?
$210.19 in the Office (non-facility) setting—the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $192.39 amount above. The non-participating amount is 95% of the fee schedule rate ($182.77), and the statutory cap is 115% of that. See limiting charge.
Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.
Who’s billing it Copy link
The allowed amount depends on who bills the service: NPs and PAs get 85% of the fee schedule amount, social workers and counselors 75%. These are national Q4 2026 figures at GPCI 1.000.
| Billed by | Office (non-facility) | Facility |
|---|---|---|
| Physician (MD/DO) 100% The full fee schedule amount. Open in calculator | $192.39 | $125.59 |
| NP, PA or CNS 85% Paid 85% of the fee schedule amount. Always takes assignment, so no limiting charge applies. Source: 42 CFR 414.52(d) · 42 CFR 414.56(c) · Pub. 100-04 ch. 12 §110 · Pub. 100-04 ch. 12 §120.A · Pub. 100-04 ch. 1 §30.3.1 Open in calculator | $163.53 | $106.75 |
| NP or PA visit billed under the physician (incident-to) 100% Paid as if the physician did it, but only in the office and only when every incident-to requirement, including supervision, is met. Source: Pub. 100-02 ch. 15 §60 Open in calculator | $192.39 | Not available |
A provider type is listed when it billed at least 1% of 99215’s Medicare services in CMS’s CY2024 Physician & Other Practitioners data. Each percentage applies before the 80/20 split and sequestration.
CMS RVU26DOctober 1 – December 31, 2026revision 2 See file rows
Which billing rules and modifiers apply? Copy link
Modifier amounts: -26/TC, -50, -80/81/82, -AS, -62, -66 Copy link
National Office (non-facility) amounts for the modifiers this code's indicators support. These are single-line modifiers only. -51 (multiple-procedure reduction) depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one. Use the calculator for a locality-adjusted, sequestration-aware amount.
| Modifier | What it means | Amount |
|---|---|---|
| -80/81/82 | Assistant surgeon (physician) · 16% | $30.78 If documented |
| -AS | Assistant at surgery (PA, NP, or CNS) · 13.6% | $26.17 If documented |
Not payable with 99215: -26/TC (professional/technical split); -50 (bilateral procedure); -62 (co-surgeons, each); -66 (team surgery).
Each amount applies a standard MPFS percentage (assistant surgeon 16%, non-physician assistant at surgery 13.6%, co-surgeon 62.5%, bilateral 150%) to the national Office (non-facility) amount above. CMS doesn't publish these as a column; Localis derives them, so check them against the current Medicare Claims Processing Manual before relying on them for payment. A row marked If documented carries the ordinary percentage, but this code's CMS indicator allows it only when documentation of medical necessity is submitted. Without that documentation, an unpaid claim is not an underpayment.
CMS RVU26DOctober 1 – December 31, 2026revision 2 See file rows
Can you bill it with another code? Copy link
Check a pair of codes Copy link
Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit for the pair.
Billing together (NCCI edits) Copy link
NCCI Q4 2026Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.
Not separately payable with 99215 on the same date of service—no modifier bypasses the edit (modifier indicator 0)
Showing 3 of 379.
Separately payable with 99215 only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)
Showing 3 of 6,014.
Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.
Check a paired code or view all 6,393 NCCI pairs →
Medically Unlikely Edit (MUE) limit: 1 unit per patient per date of service.
Billing G2211 with 99215 Copy link
Code-specificG2211 is an add-on for a qualifying visit complexity, not a higher visit level. It recognizes the added work of being a continuing focal point for a patient's care, or providing ongoing care for a serious or complex condition—the relationship, not the diagnosis or visit length, is what qualifies.
| Line | Office | Facility |
|---|---|---|
| 99215 | $192.39 | $125.59 |
| G2211 | $17.37 | $14.36 |
| 99215 + G2211 | $209.76 | $139.95 |
National amounts at GPCI 1.000, before sequestration. Use your locality.
- Medicare generally denies G2211 when 99215 is reported with modifier 25 on the same date, for the same patient, by the same practitioner—whatever the reason the modifier is there.
- A same-day clinical lab test does not by itself require modifier 25 on the visit, so it does not block G2211. Same-day minor procedures do require the modifier, and billing systems that auto-append modifier 25 for lab or point-of-care tests can strip G2211 payment unnecessarily. For dates of service on or after January 1, 2025, vaccine administration is an explicit exception; for 2024 dates of service, any modifier 25 on the base visit still blocks G2211.
- For dates of service on or after January 1, 2025, a narrow exception applies when the same-day service is an annual wellness visit, a vaccine administration, or another listed Medicare Part B preventive service—the general modifier-25 denial does not apply in that case.
- Ordinary Part B deductible and coinsurance apply to G2211—it is not a preventive service with waived cost sharing.
Sources: CMS FAQs about E/M visit complexity add-on HCPCS code G2211 and the CR 13705 allowed preventive-service list. The relationship and documentation requirements decide eligibility—this table only prices the combination once it applies. See the full G2211 guide for the relationship test, history, and the CY2027 proposal to convert G2211 into a percentage-based modifier.
Payment review for 99215 Copy link
Check the top established-patient visit separately from any prolonged-time or longitudinal-care add-ons. Combining them too early hides which line, rule, or contract percentage caused the variance.
What to check
- Compare 99215 and 99214 with the same release, locality, and setting before working out the per-visit difference.
- Keep G2212 units separate, and count them only when Medicare’s time-based rules for that date support them.
- Check G2211 on its own; a higher visit amount doesn’t replace the add-on’s relationship and same-day rules.
Compare against 99214, G2212 and G2211: their amounts are in Related codes.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS MLN: Evaluation and Management Services Guide; CMS FAQs about E/M visit complexity add-on HCPCS code G2211.
How has it changed? Copy link
Rate history by release Copy link
National Office (non-facility) amount for 99215 across quarterly releases. +34.6% increase since Q1 2013 · peak $192.39 in Q1 2026
| Release | Status | Office | Facility |
|---|---|---|---|
| Q4 2026 Oct 1, 2026 – present | A | $192.39 (0.0% no change) | $125.59 (0.0% no change) |
| Q3 2026 Jul 1, 2026 – Sep 30, 2026 | A | $192.39 (0.0% no change) | $125.59 (0.0% no change) |
| Q2 2026 Apr 1, 2026 – Jun 30, 2026 | A | $192.39 (0.0% no change) | $125.59 (0.0% no change) |
| Q1 2026 Jan 1, 2026 – Mar 31, 2026 | A | $192.39 (+9.5% increase) | $125.59 (-9.5% decrease) |
| Q4 2025 Oct 1, 2025 – Dec 31, 2025 | A | $175.64 (0.0% no change) | $138.77 (0.0% no change) |
| Q3 2025 Jul 1, 2025 – Sep 30, 2025 | A | $175.64 (0.0% no change) | $138.77 (0.0% no change) |
| Q2 2025 Apr 1, 2025 – Jun 30, 2025 | A | $175.64 (0.0% no change) | $138.77 (0.0% no change) |
| Q1 2025 Jan 1, 2025 – Mar 31, 2025 | A | $175.64 (-2.6% decrease) | $138.77 (-2.8% decrease) |
| Q4 2024 Oct 1, 2024 – Dec 31, 2024 | A | $180.42 (0.0% no change) | $142.80 (0.0% no change) |
| Q3 2024 Jul 1, 2024 – Sep 30, 2024 | A | $180.42 (0.0% no change) | $142.80 (0.0% no change) |
| Q2 2024 Apr 1, 2024 – Jun 30, 2024 | A | $180.42 (0.0% no change) | $142.80 (0.0% no change) |
| Q1 2024 Mar 9, 2024 – Mar 31, 2024 | A | $180.42 (+1.7% increase) | $142.80 (+1.7% increase) |
| Q1 2024 Jan 1, 2024 – Mar 8, 2024 | A | $177.47 (-1.4% decrease) | $140.47 (-2.0% decrease) |
| Q4 2023 Oct 1, 2023 – Dec 31, 2023 | A | $179.94 (0.0% no change) | $143.34 (0.0% no change) |
| Q3 2023 Jul 1, 2023 – Sep 30, 2023 | A | $179.94 (0.0% no change) | $143.34 (0.0% no change) |
| Q2 2023 Apr 1, 2023 – Jun 30, 2023 | A | $179.94 (0.0% no change) | $143.34 (0.0% no change) |
| Q1 2023 Jan 1, 2023 – Mar 31, 2023 | A | $179.94 (-1.7% decrease) | $143.34 (-2.5% decrease) |
| Q4 2022 Oct 1, 2022 – Dec 31, 2022 | A | $183.07 (0.0% no change) | $147.08 (0.0% no change) |
| Q3 2022 Jul 1, 2022 – Sep 30, 2022 | A | $183.07 (0.0% no change) | $147.08 (0.0% no change) |
| Q2 2022 Apr 1, 2022 – Jun 30, 2022 | A | $183.07 (0.0% no change) | $147.08 (0.0% no change) |
| Q1 2022 Jan 1, 2022 – Mar 31, 2022 | A | $183.07 (-0.1% decrease) | $147.08 (-0.6% decrease) |
| Q4 2021 Oct 1, 2021 – Dec 31, 2021 | A | $183.19 (0.0% no change) | $147.95 (0.0% no change) |
| Q3 2021 Jul 1, 2021 – Sep 30, 2021 | A | $183.19 (0.0% no change) | $147.95 (0.0% no change) |
| Q2 2021 Apr 1, 2021 – Jun 30, 2021 | A | $183.19 (0.0% no change) | $147.95 (0.0% no change) |
| Q1 2021 Jan 1, 2021 – Mar 31, 2021 | A | $183.19 (+23.5% increase) | $147.95 (+30.1% increase) |
| Q4 2020 Oct 1, 2020 – Dec 31, 2020 | A | $148.33 (0.0% no change) | $113.68 (0.0% no change) |
| Q3 2020 Jul 1, 2020 – Sep 30, 2020 | A | $148.33 (0.0% no change) | $113.68 (0.0% no change) |
| Q2 2020 Apr 1, 2020 – Jun 30, 2020 | A | $148.33 (0.0% no change) | $113.68 (0.0% no change) |
| Q1 2020 Jan 1, 2020 – Mar 31, 2020 | A | $148.33 (+0.4% increase) | $113.68 (+0.8% increase) |
| Q4 2019 Oct 1, 2019 – Dec 31, 2019 | A | $147.76 (0.0% no change) | $112.80 (0.0% no change) |
| Q3 2019 Jul 1, 2019 – Sep 30, 2019 | A | $147.76 (0.0% no change) | $112.80 (0.0% no change) |
| Q2 2019 Apr 1, 2019 – Jun 30, 2019 | A | $147.76 (0.0% no change) | $112.80 (0.0% no change) |
| Q1 2019 Jan 1, 2019 – Mar 31, 2019 | A | $147.76 (+0.1% increase) | $112.80 (-0.2% decrease) |
| Q4 2018 Oct 1, 2018 – Dec 31, 2018 | A | $147.60 (0.0% no change) | $113.04 (0.0% no change) |
| Q3 2018 Jul 1, 2018 – Sep 30, 2018 | A | $147.60 (0.0% no change) | $113.04 (0.0% no change) |
| Q2 2018 Apr 1, 2018 – Jun 30, 2018 | A | $147.60 (0.0% no change) | $113.04 (0.0% no change) |
| Q1 2018 Jan 1, 2018 – Mar 31, 2018 | A | $147.60 (+0.8% increase) | $113.04 (+0.3% increase) |
| Q4 2017 Oct 1, 2017 – Dec 31, 2017 | A | $146.43 (0.0% no change) | $112.69 (0.0% no change) |
| Q3 2017 Jul 1, 2017 – Sep 30, 2017 | A | $146.43 (0.0% no change) | $112.69 (0.0% no change) |
| Q2 2017 Apr 1, 2017 – Jun 30, 2017 | A | $146.43 (0.0% no change) | $112.69 (0.0% no change) |
| Q1 2017 Jan 1, 2017 – Mar 31, 2017 | A | $146.43 (+0.5% increase) | $112.69 (+0.6% increase) |
| Q4 2016 Oct 1, 2016 – Dec 31, 2016 | A | $145.72 (0.0% no change) | $112.07 (0.0% no change) |
| Q3 2016 Jul 1, 2016 – Sep 30, 2016 | A | $145.72 (0.0% no change) | $112.07 (0.0% no change) |
| Q2 2016 Apr 1, 2016 – Jun 30, 2016 | A | $145.72 (0.0% no change) | $112.07 (0.0% no change) |
| Q1 2016 Jan 1, 2016 – Mar 31, 2016 | A | $145.72 (-0.9% decrease) | $112.07 (-0.7% decrease) |
| Q4 2015 Oct 1, 2015 – Dec 31, 2015 | A | $146.97 (+0.5% increase) | $112.83 (+0.5% increase) |
| Q3 2015 Jul 1, 2015 – Sep 30, 2015 | A | $146.24 (0.0% no change) | $112.27 (0.0% no change) |
| Q2 2015 Apr 1, 2015 – Jun 30, 2015 | A | $146.24 (0.0% no change) | $112.27 (0.0% no change) |
| Q1 2015 Jan 1, 2015 – Mar 31, 2015 | A | $146.24 (+1.3% increase) | $112.27 (+0.8% increase) |
| Q4 2014 Oct 1, 2014 – Dec 31, 2014 | A | $144.37 (0.0% no change) | $111.41 (0.0% no change) |
| Q3 2014 Jul 1, 2014 – Sep 30, 2014 | A | $144.37 (0.0% no change) | $111.41 (0.0% no change) |
| Q2 2014 Apr 1, 2014 – Jun 30, 2014 | A | $144.37 (+1.0% increase) | $111.41 (+3.3% increase) |
| Q2 2013 Apr 1, 2013 – Jun 30, 2013 | A | $142.90 (0.0% no change) | $107.85 (0.0% no change) |
| Q1 2013 Jan 1, 2013 – Mar 31, 2013 | A | $142.90 | $107.85 |
Why 99215's rate changed Copy link
National baseline (GPCI 1.000) · Office (non-facility) · Before sequestration
99215's national amount rose $49.49 (+34.6%), from $142.90 in Q1 2013 to $192.39 in Q4 2026. Changes to the conversion factor, which CMS sets for every code, took $2.61 off. CMS revaluing 99215 itself added $52.10: +$26.71 from practice-expense RVUs, +$23.05 from work RVUs and +$2.34 from malpractice RVUs. The most recent change came in Q1 2026: +$16.75 (+9.5%), with +$11.02 from practice-expense RVUs and +$5.73 from the conversion factor.
| Release | Change | Conversion factor | Work RVUs | PE RVUs | MP RVUs |
|---|---|---|---|---|---|
| Q1 2026 from Q4 2025 | +$16.75 $175.64 → $192.39 | +$5.73 $32.3465 → $33.4009 | $0.00 | +$11.02 | $0.00 |
| Q1 2025 from Q4 2024 | −$4.78 $180.42 → $175.64 | −$5.11 $33.2875 → $32.3465 | $0.00 | +$0.65 | −$0.32 |
| Q1 2024 (from Mar 9) from Q1 2024 (from Jan 1) | +$2.95 $177.47 → $180.42 | +$2.95 $32.7442 → $33.2875 | $0.00 | $0.00 | $0.00 |
| Q1 2024 (from Jan 1) from Q4 2023 | −$2.47 $179.94 → $177.47 | −$6.07 $33.8872 → $32.7442 | $0.00 | +$2.95 | +$0.65 |
| Q1 2023 from Q4 2022 | −$3.13 $183.07 → $179.94 | −$3.81 $34.6062 → $33.8872 | $0.00 | +$1.02 | −$0.34 |
| Q1 2022 from Q4 2021 | −$0.12 $183.19 → $183.07 | −$1.50 $34.8931 → $34.6062 | $0.00 | +$1.38 | $0.00 |
| Q1 2021 from Q4 2020 | +$34.86 $148.33 → $183.19 | −$4.92 $36.0896 → $34.8931 | +$24.08 | +$13.61 | +$2.09 |
| Q1 2020 from Q4 2019 | +$0.57 $147.76 → $148.33 | +$0.21 $36.0391 → $36.0896 | $0.00 | +$0.36 | $0.00 |
| Q1 2019 from Q4 2018 | +$0.16 $147.60 → $147.76 | +$0.16 $35.9996 → $36.0391 | $0.00 | $0.00 | $0.00 |
| Q1 2018 (from Jan 1) from Q4 2017 | +$1.17 $146.43 → $147.60 | +$0.45 $35.8887 → $35.9996 | $0.00 | +$0.72 | $0.00 |
| Q1 2017 from Q4 2016 | +$0.71 $145.72 → $146.43 | +$0.34 $35.8043 → $35.8887 | $0.00 | +$0.37 | $0.00 |
| Q1 2016 from Q4 2015 | −$1.25 $146.97 → $145.72 | −$0.53 $35.9335 → $35.8043 | $0.00 | −$0.36 | −$0.36 |
| Q4 2015 from Q3 2015 | +$0.73 $146.24 → $146.97 | +$0.73 $35.7547 → $35.9335 | $0.00 | $0.00 | $0.00 |
| Q1 2015 from Q4 2014 | +$1.87 $144.37 → $146.24 | −$0.27 $35.8228 → $35.7547 | $0.00 | +$1.07 | +$1.07 |
| Q2 2014 from Q2 2013 | +$1.47 $142.90 → $144.37 | +$7.56 $34.0230 → $35.8228 | $0.00 | −$5.73 | −$0.36 |
CMS doesn't publish this split; we derive it from each release's RVUs and conversion factor. We apply the new conversion factor to the earlier RVUs first, then price each RVU change at the new conversion factor. Another order would move a few cents between columns, but every total stays the same.
Code and billing changes Copy link
The most relevant verified changes to this code and related Medicare billing policy.
Planned Full interactive timeline, two-date comparison, and an exportable citation packet.
Effective Jan 1, 2025
G2211 gained a limited modifier 25 exception
Medicare began allowing G2211 with a qualifying office/outpatient E/M base code, 99202-99205 or 99211-99215, with modifier 25 when an annual wellness visit, vaccine administration, or another CMS-listed eligible Part B preventive service is also furnished on the same date in the office or outpatient setting.
Effective Jan 1, 2021
The 40-54 minute time range took effect
When time is used instead of medical decision making to select 99215, the applicable total-time range is 40-54 minutes on the encounter date.
This amount has been unchanged since Q1 2026, when it increased 9.5%.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.
The 99215 rate last moved in Q1 2026. See its rate history.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
Usage and related codes Copy link
How often 99215 is billed Copy link
Across Original Medicare in CY2024, 99215 ranked #8 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars. It repeats: a patient billed for it in 2024 was billed 2.0 times on average that year.
2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q4 2026 fee schedule above.
Who bills 99215 to Medicare
Observed CY2024 Medicare fee-for-service billing, by the rendering clinician's CMS specialty. Each share is that specialty's slice of all observed services for this code that year.
Setting split that year: 80% Office (non-facility) · 20% facility. CMS publishes only this facility vs non-facility split, never the exact place of service. The Office (non-facility) figure does not identify urgent care or any other specific setting.
CY2024 Medicare fee-for-service only, from the CMS Physician & Other Practitioners dataset, which suppresses rows under 11 beneficiaries. We omit specialty groups with fewer than 30 observed clinicians, so the shares can fall short of 100%. Specialty and practice-type pages linked elsewhere on this page are curated code lists, not utilization claims.
How 99215 compares with other codes Copy link
Against every code with a national PFS amount in Q4 2026 · National baseline · Before sequestration
- +53.2% Office over facility
- 99215's Office amount is $66.80 more than its facility amount, because a facility bills its own overhead separately. Of the 7,745 codes priced in both settings, 2,167 have a higher Office amount. 99215's gap is smaller than 67% of theirs; the median gap is +78.1%.
- 37.5% Highest vs. lowest locality
- 99215's Office amount is 37.5% higher in its highest-paid payment locality than in its lowest. That spread is narrower than 91% of the 7,716 codes compared; the median spread is 43.6%. How much a code's amount varies by locality depends on its mix of work, practice-expense and malpractice RVUs, since each has its own GPCI.
- +34.6% Since Q1 2013
- 99215's Office amount rose 34.6% from Q1 2013 to Q4 2026. Over the same period, the median code's amount fell 6.6%. That's higher than the change for 97% of the 6,418 codes priced in both releases.
These comparisons cover every code with a national Physician Fee Schedule amount: status A, R or T, with no blank RVUs. The locality comparison leaves out codes with an OPPS cap, because the cap, not the GPCIs, can set their amount in some localities.
Did this answer your question about CPT 99215?
Tell us what you were trying to work out and we'll answer you or build the page that does.
Source & method
Show sources
Hide
This page uses CMS's Medicare Physician Fee Schedule Q4 2026 release (effective October 2026). National baselines use GPCI 1.000 and exclude sequestration. Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero. Past releases are never edited, so these sources stay valid after CMS publishes a newer one. The commercial rates above are the only figures on this page that CMS did not publish. Payers published them in their own Transparency in Coverage files. Modifier amounts apply standard MPFS percentages to this code's billing indicators. We derive them here rather than read them from CMS, so confirm them against the current Claims Processing Manual before relying on them for payment. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before we publish them.
Localis context written from primary sources: CMS Medicare Physician Fee Schedule Relative Value Files. Not derived from AMA CPT descriptor text.
Conversion factor $33.4009 read from the same file, row 13,017, column 26.
The price card’s citations show the exact row, columns, and file lines behind each amount.
Cite this rate
The citation names the release, so anyone can check it even after CMS publishes a newer one.
CPT 99215 National PFS baseline: Office (non-facility) $192.39; Facility $125.59 (Q4 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26D, PPRRVU2026_Oct_nonQPP.csv row 13,017. Localis. https://localishealth.com/cpt/99215/2026/D