CPT 99211
Global XXX ActiveOff/op est may x req phy/qhp
CPT 99211 Billing & Documentation Guide
CPT code 99211 (Off/op est may x req phy/qhp) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.18, a non-facility practice expense RVU of 0.54, and a malpractice RVU of 0.01, a total non-facility RVU of 0.73 and facility RVU of 0.23. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $25.24, though rates vary from $21.68 to $32.86 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99211, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99211 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 99211 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99211
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.18 | 0.18 |
| Practice Expense RVU | 0.54 | 0.04 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 0.73 | 0.23 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99211
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $27.75 | $7.99 | $26.06 - $32.86 | 29 |
| Florida | $24.76 | $8 | $23.76 - $25.63 | 3 |
| Georgia | $23.63 | $7.7 | $22.5 - $24.76 | 2 |
| Illinois | $24.1 | $7.96 | $23 - $25.17 | 4 |
| Michigan | $23.42 | $7.74 | $22.86 - $23.98 | 2 |
| North Carolina | $23.05 | $7.47 | $23.05 - $23.05 | 1 |
| New York | $26.87 | $8.24 | $23.38 - $28.46 | 5 |
| Ohio | $22.82 | $7.57 | $22.82 - $22.82 | 1 |
| Pennsylvania | $24.09 | $7.73 | $22.89 - $25.29 | 2 |
| Texas | $24.11 | $7.67 | $22.74 - $25.4 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99211
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99211 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0074T | Column 1 (primary), can be billed with modifier | 9 | CPT Manual or CMS manual coding instruction |
| 0115T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0116T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0359T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0360T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0361T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0363T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0364T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 99211
What does CPT code 99211 mean? +
CPT code 99211 represents: Off/op est may x req phy/qhp. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99211? +
The 2026 Medicare national average non-facility payment for CPT 99211 is $25.24. Rates range from $21.68 to $32.86 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99211? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99211? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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