CPT 99215 is the highest level of office visit for an established patient: around 40 minutes, high complexity, usually a serious problem or several chronic conditions reviewed at once. It is billed for follow-up visits that involve significant decisions, not for routine check-ins.
What the price covers
When a hospital lists this code, it is the price at a hospital-owned clinic, which may add a facility fee to the clinician's fee. Tests and procedures during the visit are separate.
Established-patient levels
- 99212: about 10 minutes, straightforward
- 99213: about 20 minutes, low complexity (the most common visit)
- 99214: about 30 minutes, moderate complexity
- 99215: about 40 minutes, high complexity (this page)
Most follow-ups are 99213 or 99214. If you are routinely billed 99215 for short visits, ask why.
Why prices vary
Facility fees at hospital-owned practices are the main reason the same visit costs more at some places. Cash prices are often well below gross charges.
Questions to ask
- What is the self-pay price for 99215, and is there a facility fee?
- Which level is typically billed for my follow-ups?
- What is billed separately?