Code 99215 represents an existing patient appointment that’s at least 40 minutes in duration.
December 9, 2024
10 min read
The 99215 code is an E/M code used by prescribing providers. For other E/M codes, visit this overview.
Code 99215 represents an existing patient appointment that’s at least 40 minutes in duration. It’s a prescriber code, which means it’s most commonly used by psychiatrists or nurse practitioners.
This is is how the American Medical Association defines 99215 in the official CPT codebook:
CPT code 99215: Existing patient office visit, minimum 40 minutes
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
If you’re treating a new patient, you should use 99205 instead. A new patient is someone you have not seen in the last three years.
It’s important to use the code that most accurately reflects the time you spent with the patient to treat their condition, and ensure that documentation for the session supports the chosen code.
Simplify insurance and save time on your entire workflow — from compliance and billing to credentialing and admin.
Documentation for 99215 is essentially the same as other E/M codes, but geared toward an existing patient.
In the example note below, the following factors are present:
The encounter meets the criteria for a 99215 code based on the high level of medical decision-making required for managing the severe exacerbation of bipolar disorder, including consideration of hospitalization.
The treatment plan involves high-risk decision-making regarding acute intervention and crisis management to address the immediate safety and stabilization needs of the patient.
Patient Name: Whitney Johnson
Date of Service: 10/24/2024
Patient DOB: 09/12/1990
Appointment Time: 10:00 am – 10:50 am
Place of Service: Patient was located at their home at 123 Main St Anywhere US 12345
Provider was located at their office: 456 Storybook Ln Hollywood CA 96852
This session was provided via a HIPAA compliant interactive audio/video platform. The patient consented to this telemedicine encounter.
Chief Complaint: Urgent follow-up for a 34-year-old female with severe exacerbation of bipolar disorder symptoms, including anxiety and suicidal ideation with a plan to overdose if symptoms worsen.
HPI:
Ms. Johnson reports significant mood instability, with manic episodes characterized by impulsivity and racing thoughts, and depressive episodes marked by hopelessness and suicidal ideation. She also describes heightened anxiety, worsening during periods of alcohol cravings or social exposure. Although she has not relapsed, she feels overwhelmed by her anxiety, fearing it could trigger drinking again.
Allergies: No known drug allergies.
Substance Use Assessment: History of alcohol dependence with associated anxiety (F10.280). Currently not drinking but reports intense cravings during stressful episodes.
Exam:
Vital signs within normal limits. Patient exhibits psychomotor agitation during manic episodes and psychomotor retardation during depressive episodes. Mood observed as highly labile, with periods of elevated affect and tearfulness.
MSE:
Dx: F31.63 Bipolar disorder, current episode mixed, severe, without psychotic features
F10.280 Alcohol dependence with alcohol-induced anxiety disorder
1. Consideration for Inpatient Admission: Due to the severity of Ms. Johnson’s bipolar exacerbation and the anxiety related to alcohol dependence, inpatient psychiatric hospitalization was considered. After collaborative discussion, hospitalization will be deferred, contingent upon the patient’s agreement to follow a structured safety plan.
2. Pharmacological Intervention:
3. Safety Plan and Patient Agreement:
4. Relapse Prevention and Coordination of Care:
Electronically signed by:
[Provider Name, Credentials, Date]
_____________________________________________________________________________________________
Rationale information is not required in your note; it is provided for educational purposes only.
Number and Complexity of Problems Addressed: 2 chronic illnesses Bipolar disorder with severe exacerbation and Alcohol dependence with alcohol-induced anxiety disorder.
Data Reviewed/Analyzed: None.
Risk of Complications and/or Morbidity: High risk, consideration of inpatient admission
Rationale: This encounter qualifies for a 99215 code due to the high level of medical decision-making involved, including managing a severe exacerbation of bipolar disorder and coordinating inpatient hospitalization for stabilization and crisis management.
CPT Code Selected: 99215
Reimbursement rates for sessions billed with 99215 will vary depending on factors like the specific payer contract, your geographic location, and type of therapy license. Headway providers can check the portal for rates with each insurance provider.
This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.
Simplify insurance and save time on your entire workflow — from compliance and billing to credentialing and admin.
This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.
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Understand the ins and outs of CPT codes to help make documentation and billing more efficient — and give you more time to focus on other areas of your practice.
Headway strives to simplify billing insurance so you can focus on providing care. Read our comprehensive guide to mental health billing.
Understand the ins and outs of CPT codes to help make documentation and billing more efficient — and give you more time to focus on other areas of your practice.
