Can you bill 99213 for a nurse visit?
Asked by: Ayla Turner | Last update: June 10, 2025Score: 4.3/5 (28 votes)
What are the billing guidelines for 99213?
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.
Can you bill for a nurse visit?
A: The 99211 E/M visit is a nurse visit and should be used only by a medical assistant or a nurse when performing services such as wound checks, dressing changes or suture removal. CPT code 99211 should never be billed for physician, physician assistant or nurse practitioner services.
Can you bill 99213 for telehealth visit?
During the COVID-19 public health emergency, many physiatrists are performing standard office visits via telehealth. These services should be billed using standard E/M codes. For example, a level 3 office visit provided to an established patient via telehealth should be billed using code 99213.
What is the ICD code for nursing visit?
To support the 99211 code for a nursing visit, a practice must have sufficient documentation.
Billing Nurse Visits
What constitutes a nurse visit?
CPT defines this code as an “office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician.” It further states that the presenting problems are usually minimal, and typically five minutes are spent performing or supervising these services.
Can you charge a copay for a nurse visit?
A patients co-pay may well end up covering most of the visit, which is coded using CPT 99211 . Some practices feel hesitant about asking for a co-pay under these circumstances. Regardless of what the nurse does, if you charge for an office visit, you should, in most cases, bill the patient a co-pay, our sources say.
Can a nurse practitioner bill a 99213?
It is generally considered to be a moderate-length visit that involves a comprehensive assessment and treatment plan. The 99213 code is used by a wide range of healthcare professionals, including physicians, nurse practitioners, and physician assistants.
When to bill 99213 vs 99214?
The primary difference between CPT code 99213 and 99214 lies in the complexity and time involved. While 99213 is for a low level of medical decision-making, 99214 is used for moderate complexity, requiring a higher level of medical decision-making and more extensive history and examination.
Do you have to pay for nurse visits?
Yes, you may be billed for a nurse visit and an injection. Each service that is provided at the visit has a charge associated with it. Therefore, the visit is one charge, and you will see additional charges for any injections or vaccines you received during the visit.
How to document a nurse visit?
Can nurses bill E&M codes?
What codes can an RN bill for? Insurance reimbursement coding is based on the American Medical Association CPT² coding system. Under that system, the only Evaluation and Management (E/M) code that a registered nurse can bill to is 99211.
What does a 99213 reimburse?
Accurate Reimbursement for Moderate Complexity Services
Physical therapy sessions vary widely in complexity. CPT Code 99213 allows physical therapists to accurately bill for visits that involve moderate complexity, rather than assigning a lower code that may not fully capture the level of service provided.
Is 99213 a preventive code?
However, if you bill an additional office visit code (for example, 15 minute expanded problem visit code 99213 with modifier 25), this is NOT considered a preventive service, and may be subject to deductibles, copays or coinsurance.
Is CPT code 99213 covered by Medicare?
Medicare will pay a physician for an AWV service and a medically necessary service, e.g. a mid-level established office visit, Current Procedural Terminology (CPT) code 99213, furnished during a single beneficiary encounter.
What are the rules for 99213?
- Medical Necessity: Healthcare providers need to explain why the visit was needed. ...
- Time-based Documentation: Providers need to spend 20-29 minutes with the patient, which is surely required to help them with decision-making.
What is an example of a 99213 visit?
An example of a 99203 or 99213 is a sinus infection treated with an antibiotic. Although the prescription makes the risk component moderate, the one acute uncomplicated illness is a low-complexity problem, and there are no data points.
Does 99213 need a modifier?
If the circumstance calls for a Level 3 established patient visit (CPT code 99213) to be billed with psychological testing (such as CPT code 96101), modifier 59 would be appended to the testing code.
What CPT codes can nurse practitioners use?
CPT codes for NP visits
Are there CPT codes that specify when a patient sees a nurse practitioner (NP) in a physician's office? No. Generally, when an NP or physician assistant (PA) sees a patient in a physician's office, he or she should use the usual office or other outpatient visit codes (99201-99215).
Can you bill 99395 and 99213 together?
can be used 99213 with 99395 at the same visit? Absolutely! You would use the modifier -25 on the 99213. Look at the Preventive Medicine section in CPT® and this is outlined in the narrative explanation prior to the actual listing of codes.
Do nurse practitioners bill the same as physicians?
Billing and Reimbursement
Payment is made at the lesser of the amount billed or 100 percent of the amount payable to a physician for the same service. No separate reimbursement is made for physician supervision of an NP.
What is the diagnosis code for a nurse visit?
CPT code 99211 is often called the nurse visit code. But it's not just for nurses! Many of your practice employees can provide the service. They must be qualified to evaluate and meet the patient's care needs in a limited capacity.
What is the CPT code for nurse visit in 2024?
CPT code 99211 is defined as a minimal, low-level Evaluation and Management (E/M) service, often referred to as a “nurse visit”, and has a CMS national allowable of $23.30 for the 2024 calendar year.
Can 99211 be billed as telehealth?
How is an office visit conducted via audio-video billed? Office visit evaluation and management services (CPT codes 99202-99205, 99211-99215) furnished using audio-video telecommunications technology are reported using the same CPT codes as you would have had the visit been conducted in-person.