99215 Office outpatient established hi 40 minutes
Also known as: complex office visit, high complexity, comprehensive visit, established patient office visit level 5, high complexity visit, complex visit, comprehensive office visit
Office or other outpatient visit for the evaluation and management of an established patient with high medical decision-making complexity and an expected duration of 40 minutes.
In Plain Language
Comprehensive medical visit; Extended appointment
Clinical Context
Used for established patient office visits requiring high medical decision-making complexity, such as new diagnosis of significant condition, complex medication adjustments, or management of multiple acute and chronic conditions.
RVU Breakdown
| Work RVU | 2.80 |
| Total RVU | 2.80 |
Est. Medicare Payment
National estimate based on 2026 CMS PFS Conversion Factor ($33.40). Actual payment varies by locality (GPCI adjustment).
Billing & Documentation
E&M codes require documentation of medical decision-making (MDM) complexity or total time spent on the encounter. For 2026, time-based coding includes all physician time on the date of the encounter.
How This Code Compares
With a work RVU of 2.80, this code ranks in the 84th percentile among Evaluation & Management codes — 1.8x the median (1.54). The highest wRVU in this category is 18.46.
Specialties
Frequently Asked Questions
What is CPT code 99215?
CPT 99215 (Office outpatient established hi 40 minutes) is a Evaluation & Management code. Office or other outpatient visit for the evaluation and management of an established patient with high medical decision-making complexity and an expected duration of 40 minutes.
Who uses CPT code 99215?
CPT 99215 is used by Family Medicine, Internal Medicine, All Specialties. Used for established patient office visits requiring high medical decision-making complexity, such as new diagnosis of significant condition, complex medication adjustments, or management of multiple acute and chronic conditions.
When is CPT 99215 used?
Used for established patient office visits requiring high medical decision-making complexity, such as new diagnosis of significant condition, complex medication adjustments, or management of multiple acute and chronic conditions.
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CPT® is a registered trademark of the American Medical Association. Data sourced from CMS Physician Fee Schedule RVU26A. Descriptions, synonyms, and clinical context are original content by RVU Edge.