# CPT 99215

> Medicare paid $146.43 for CPT 99215 in the office (non-facility) setting and $112.69 in a facility under the Q3 2017 Physician Fee Schedule, effective July 2017. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2017, when it increased 0.5%.

## What it is

The most complex established-patient office visit — for example, a severe flare of a chronic illness, or a new problem that threatens life or bodily function and requires a high-risk management decision such as a major medication change or weighing hospitalization. Total visit time typically runs about 40 to 54 minutes, and documentation must support high complexity in the problems addressed, the data reviewed, and the risk of the management plan. It is the highest-level established-patient office visit.

## Selected release

- Release: Q3 2017 (2017 C)
- Effective: July 1 – September 30, 2017
- Status indicator: A
- Office (non-facility) national allowed amount: $146.43
- Facility national allowed amount: $112.69
- Sequestration: not applied

## RVUs and formula

- Work RVU: 2.11
- Office (non-facility) practice expense RVU: 1.82
- Facility practice expense RVU: 0.88
- Malpractice RVU: 0.15
- Conversion factor: 35.8887
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## Source and citation

- Source: Physician relative value file (Q3 2017)
- CMS file: https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu17c.zip
- Parsed file: PPRRVU17_JULY_V0503.csv, row 16,340
- Canonical page: https://localishealth.com/cpt/99215/2017/A
- Release-specific citation URL: https://localishealth.com/cpt/99215/2017/C
- Last significant update: 2026-08-04T03:07:49+00:00