CPT 99212: Established Patient Office/Outpatient Visit, Straightforward
Medicare pays $61 and commercial payers pay $75 on average nationally for this procedure.
CPT code 99212 describes an evaluation and management office or other outpatient visit for an established patient with a straightforward level of medical decision making or with 10 or more minutes of total provider time on the date of the encounter; the service type is an established patient office/outpatient E/M visit and the typical site of service is an office or outpatient clinic.
For related coverage guidance, see recent payer policy updates: Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults, Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in Adults, Site of Service Ambulatory Service Center (ASC) Select.
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National Reimbursement Benchmarks
Across national payers, Medicare's mean of $61.5 sits slightly below BUCA's average commercial mean of $75.2, indicating BUCA reimburses on average about $13.7 more per 99212 than Medicare. That gap highlights modest commercial premiuming versus the federal program for this CPT code, with Medicare's mean clustered near its median and interquartile values ($58–$63).
Dispersion measured as P75 minus P25 is widest for Blue Cross Blue Shield at $62.0 ($114.9–$50.9) and for Aetna at $33.3 ($70.6–$37.3), while the tightest spread appears for Medicare at $5.0 ($63–$58) and Cigna at $36.6 ($72.0–$35.4). UnitedHealth Group's IQR is $36.7 ($75.0–$39.3) and BUCA's IQR is $48.7 ($96.8–$45.1), placing them in the middle of the dispersion range.