CPT 99215: Office Visit - Established Patient - High Complexity
Established patient office visit with high level of medical decision making.
Documentation Requirements
- Comprehensive history of present illness
- High complexity medical decision making OR 40-54 minutes total time
- Highly complex problem assessment
- High risk treatment or decision making
Billing Tips
- Document 1+ chronic illness with severe exacerbation OR acute illness threatening life/function
- High risk: drug therapy requiring intensive monitoring, decision regarding hospitalization
- Extensive data review or independent interpretation
- Time-based: 40-54 total minutes
Frequently Asked Questions
When is 99215 appropriate?
99215 is appropriate for patients with acute/chronic illnesses posing threat to life or function, or requiring high risk treatment decisions. Examples: cancer treatment planning, unstable heart failure, acute respiratory failure.