Can Chiropractors Bill 99211?

September 15th, 2014

This code would be used rarely in a chiropractic office. 99211 is a low complexity examination for an established patient. It can be used by chiropractors, but in most instances, it is discouraged.

The 99211 code, also known as the nurse's code, is not really made for the physician to use.  In fact, the AMA, CPT book states "may not require the presence of a physician". In the medical setting, it might be used for a visit where the nurse just takes blood pressure, or records the patient's response to a new medication. 

This code is bundled into the manipulation code and therefore should not be used on the same day as a Chiropractic Manipulative Treatment except when it is significant and separately identifiable. 

Some practices have erroneously tried to increase reimbursement by submitting 99211 along with therapies supervised by non-physician personnel every time the service is performed. The rationale is that this code pays for the presence of someone other than the doctor. However, the "practice expense" portion of the "Relative Value Unit" includes reimbursement for office overhead required to perform the therapy code, therefore, reporting the 99211 may be considered a sort of "double dipping".  

However, if a re-evaluation or assessment is performed in addition to the therapy, then an E/M code may be appropriate. Note that the criteria for a 99212 are very easy to meet, and a typical periodic re-evaluation in a chiropractic office is almost always a higher complexity than that seen in the 99211 code. 99211 only calls for a presenting problem that is minimal and does not require any of the three key components needed for other E/M codes. Therefore, chiropractors would very rarely use it as a re-evaluation code since a re-exam typically meets the criteria for at least a 99212.

So when can it be used? If the patient comes in for a follow-up visit and no adjustment is performed, then possibly a 99211 may be used. An example might be when a staff member pulls a chart, and an assistant gathers some sort of information from the patient and records it.  

Palmetto Medicare suggests that the following criteria should be met:

If there is no presenting problem, and no treatment is given, consider a preventive medicine code instead, such as 99401 (but the provider must perform this service).  

As you can see, there are possibilities, but it should be used on an occasional basis at most.


Can Chiropractors Bill 99211?. (2014, September 15). Find-A-Code Articles. Retrieved from

© InnoviHealth Systems Inc

Article Tags  (click on a tag to see related articles)

Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (8-5 Mountain)
free demo
request yours today
free subscription
for any budget

Thank you for choosing Find-A-Code, please Sign In to remove ads.