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How and When to Use the 99211 CPT Code

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Knowing how and when to use the 99211 CPT code can help you boost your clean claims and timely reimbursements. When it comes to mental and behavioral health billing, understanding how to properly apply certain codes to the services you render is essential for maximizing your revenue. Through every patient visit, there are services rendered. Whether those services are a consultation, an evaluation, psychotherapy, or something else, each service has a code associated with it for billing. Knowing these codes is important because if you identify a service with the wrong code, insurance payers will make sure that claim is denied, delaying your reimbursement. 

So what services does the 99211 CPT code cover and when should providers make sure they use it? 

Breaking Down the 99211 CPT Code 

The 99211 CPT code is an insurance billing procedural code that describes a rendered service as an “evaluation and management at an office or outpatient visit with an established patient.”

The important things to note about this code are that it is considered an evaluation and management visit and is to be with an already established patient. This evaluation/management visit can be rendered by an ancillary of the client’s provider and billed as though their provider was the one rendering the services. This code is typically used in this manner and if the visit is being conducted by the psychiatrist themselves, then other codes would be used. 

How Long is An Evaluation Allowed to Last?

The 99211 CPT code is to be billed for evaluation and management visits lasting no longer than 5 minutes and is typically used by an ancillary to the client’s psychiatrist such as a registered nurse. Visits that last longer are billed and linked to other CPT codes. Those codes are: 

99212 – an evaluation and management visit lasting no longer than 10 minutes. 

99213 – an evaluation and management visit lasting no longer than 15 minutes. 

99214 – an evaluation and management visit lasting no longer than 25 minutes 

99215 – an evaluation and management visit lasting no longer than 40 minutes. 

Which code is used and how long a visit lasts is typically linked to the client’s symptoms or conditions. The lesser their symptoms, the less time the visit will take. 

Requirements for This Code:

  1. Billing Frequency: Not all billing codes can be billed an infinite amount of time. For the 99211 CPT code, the billing frequency is decided by the client’s insurance. Medicare providers can also bill this code. Check with the client’s insurance to see what their limit for the 99211 CPT is and how often you are allowed to bill it. 
  2. Must be an Established Patient: This service cannot be billed for new patients. If your client is a new patient and you use this code, the claim will be denied. 
  3. Visit Must be Face-to-Face: This can mean a few different things. Today, face-to-face means via telehealth or in-person. This code cannot be used for service rendered over the phone. 
  4. Evaluation and Management: This can mean that the client’s history was discussed or reviewed or that some type of assessment took place and decisions were made regarding the client’s care. A clinical need but be identified and treated. 
  5. Bill Separately: If a provider rendered other services to their client on that same day, then they need to bill the 99211 CPT code separately. 
  6. There are key components required in the subsequent CPT codes (99212-99215), but not for 99211. It only needs to have enough information for why the service was rendered, when, for what reason, and any other relevant information. 

How to Bill This Code Accurately Every Time:

If providers want to be able to bill this code accurately and avoid time-wasting denials then they need medical billing software. The right software can help you code accurately, check claims for errors, submit those claims to insurance, track them through the claim process, and so much more. Providers who file claims manually are more likely to code claims incorrectly, delaying their payment and forcing them to go through the resubmission process if they want to get paid. 

The key to finding quality billing software is to find one with all of these tools but to also pinpoint a quality software vendor. The right vendor can simplify the implementation process and give you the resources you need to succeed. 

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