CPT Code 99211 is defined (by the American Medical Association’s CPT Manual) as an evaluation and management (E/M) service for an established patient that may not require the presence of a physician or other qualified healthcare professional. CPT Code 99211 remains one of the most misunderstood and misrepresented services in all of CPT Coding. One of the key requirements is that the encounter must be directed by a physician/QHCP and include actual evaluation and management. CPT Code 99211 should not be reported for telephone calls, injection visits, blood pressure checks, lab draws, etc.
Although the physician does not have to “personally” evaluate the patient, direct supervision of ancillary clinical staff is required for billing purposes. In today’s session, we discuss the appropriate use and application of CPT Code 99211 in 2025, clinical documentation requirements, who can render 99211, redline 99211 case studies together, highlight best practices, and so much more.
Led by industry expert Toni Elhoms, this session will provide a comprehensive overview of CPT Code 99211 as it applies in 2025. Attendees will gain clarity on proper usage, clinical documentation requirements, and the types of healthcare professionals authorized to report this code. The session will also explore common pitfalls, services that do not qualify for 99211, and walk through real-world case studies to reinforce key concepts. Whether you're new to 99211 or need a refresher, this session will equip you with the practical insights needed to ensure accurate and compliant reporting.
Toni Elhoms, CCS, CRC, CPC, AHIMA-Approved ICD10-CM/PCS Trainer is a nationally known speaker and recognized subject matter expert on medical coding, reimbursement, and revenue cycle management. She is the Founder and CEO of Alpha Coding Experts, LLC. She holds multiple credentials with the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). With over a decade of industry experience, she has led and supported hospital systems, universities, physician practices, payers, government agencies, and other entities on coding, billing, and compliance initiatives. She is a frequent contributor to various media outlets, speaker, and regular guest on industry podcasts. She created the Alpha Coding Podcast series to share her industry Pro-Tips. She also leads and mentors a network of revenue cycle management professionals across the country and serves as the President of the Orlando, FL AAPC Chapter.
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