CPT Code 99214: E/M Office Visit, Established Patient, Moderate Complexity
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making
CPT 99214 reports a moderate complexity E/M visit for an established patient, or 30 to 39 minutes total time.
When to use CPT 99214
Use for an established patient with moderate complexity MDM (two stable chronic conditions, one chronic with exacerbation, one acute illness with systemic symptoms) or 30 to 39 minutes total time.
Documentation requirements
- MDM or total time supporting moderate level
- Medically appropriate history and exam
Reimbursement
$110 to $140
National averages only. Rates vary by locality, payer, and fee schedule. Verify with your contracted payers.
Common modifiers
- -25
Common denial reasons for CPT 99214
- Level not supported by MDM or time
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