October 5, 2023
Do you have any source documents on examples of what services a non-physician/QHCP can bill 99211 for? What type of healthcare professionals can bill this code? What are the documentation, signature, and supervision requirements? Can 99211 be billed for long conversations with the MA?
Thank you for your inquiry. CPT code 99211 is not typically used by physicians or NPs and PAs. This code was developed for nurse visits (e.g., RN, LPN/LVN, or MA) within the physician office setting (place of service 11). These services must be in person (face-to-face) and are not billable for telephone calls. The nurse should document any history, reason for the visit, and details about the service provided. Here are a few examples of the type of visits that were shown in the CPT 2020, Appendix C. These examples were removed from CPT in 2021 when the revised office/outpatient Evaluation and Management guidelines were introduced.
Examples of 99211:
- Office visit for a 14-year-old, established patient, to re-dress an abrasion. (Orthopedic Surgery)
- Office visit for a 58-year-old male presenting for nursing examination of a wound. Patient had incision and drainage of abscess in the ER. (General Surgery)
- Office visit for an established patient for dressing change on a skin biopsy. (Dermatology/Podiatry Surgery).
- Office visit for a 45-year-old female, established patient, three weeks post simple repair of scalp laceration, noted a retained suture in healed wound, removed by nurse. (Plastic Surgery)
- Office visit for a 50-year-old male, established patient, for removal of uncomplicated facial sutures. (Plastic Surgery)
Since the service will be billed under the physician who is on-site supervising the nurse (this is called “Incident-to” billing, in addition to the above requirement for the billing physician to be on-site, there must be an order in the chart for the service to be provided and the billing physician should co-sign the nurse’s documentation.
*This response is based on the best information available as of 10/5/23.