CPT Code 99215 – High Complexity E/m Billing Guide [+Reimbursement]

Learn how to bill for Psychiatry E/M code 99215 with this ultimate guide. Wondering if there’s a more efficient way? Contact us with your billing questions!

CPT Code 99215 Definition

Evaluation and management of an established patient in an office or outpatient location for 40 minutes.

Procedure Code 99215: Evaluation and Management Description

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three components to be present in the medical record:CPT Code 99215 Components

  • A problem focused history
  • A problem focused examination
  • Decision making regarding treatment is high complexity

It’s important to note that the presenting problem(s) are high complexity. Physicians typically spend 40 minutes face-to-face with the patient and/or family.

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99215 Billing Tip!

Remember that you only need two of the three elements, so you can bill for taking history and medical decision making. Don’t worry if you haven’t done an exam, as long as the appointment is 40 minutes and you’ve completed the other two elements! This will help you bill more frequently for code 99215.

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CPT Code 99215 Time LengthCPT code 99211 time length

Length of time for code 99215 is 40 minutes. See the table for time length for all E/M visits.

Have questions about billing? Don’t forget to check out our Beginner’s Guide to Mental Health Billing!

99212 vs 99213 vs 99214 vs 99215:  Evaluation and Management

Generally, these billing codes are differentiated by amount of time spent with the patient and severity of the presenting problem. They are all part of HCPS, the Healthcare Common Procedure Coding System. Use 99215 for patients whose appointments are 40 minutes and whose treatment is considered as being of high complexity. Other CPT code severity requirements are listed below:E/M CPT Codes

  • 99212: straightforward
  • 99213: low
  • 99214: moderate
  • 99215: high

Wondering if there’s an easier way to navigate billing codes? Consider hiring a team of billing experts at Therathink.

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Can I use a Modifier with 99215?

You may be wondering if you can use a modifier with procedure code 99215.

You may use the modifier -21 if your appointment is longer than 40 minutes. Because 99215 is the longest E/M code for established patients (40 minutes), modifier -21 will allow you to bill for extra time.

Check out our guide to Psychiatric CPT codes here!

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CPT Code 99215 Reimbursement Rate

Medicare reimburses for procedure code 99215 at $148.33.

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Procedure Code 99215 Reimbursement Rates – Medicare

CPT CodeService TimeRate
9921210 minutes$46.13
9921315 minutes$68.10
9921425 minutes$110.43
9921540 minutes$148.33

99215 Reimbursement Rates – Medicaid

CPT CodeService TimeRate
9921210 minutes$31.36
9921315 minutes$43.23
9921425 minutes$66.80
9921540 minutes$99.95

99215 Commercial Insurance Reimbursement Rates According to Medicare

Here are the rates that Medicare believes are the commercial insurance rates for these services (this is not the Medicare rate for 99215):

CPT CodeService TimeRate
9921210 minutes$90
9921315 minutes$90
9921425 minutes$90
9921540 minutes$148

These rates are adjusted down and reflect what Medicare has deemed are average rates for most psychiatrists across the United States. These rates are adjusted by Medicare.

Some insurance companies only pay 15% over the Medicaid rate in their state, whereas others pay 45%, 60%, 80%, 85% on top of their state’s medicaid rate.

You can see these rates vary across insurance companies. It’s important to keep this in mind when working on your mental health insurance credentialing applications.

Reach out for help from us about suggestions!

Sources

http://www.naabt.org/documents/coding_examples.pdf

https://www.cms.gov/apps/physician-fee-schedule/search/search-results.aspx?Y=0&T=0&HT=0&CT=0&H1=99215&M=1

https://www.aafp.org/fpm/2003/1000/p31.html#:~:text=CPT%20defines%20a%2099214%20or,of%20the%20level%20of%20service.

https://www.aafp.org/fpm/1999/0500/p18.html

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