99214 CPT CODE DESCRIPTION
99214 CPT Code: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history, a detailed examination, and medical decision-making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face to face with the patient and/or family.
Level 4 Established Office Visit (99214)
This code represents the second-highest level of care for established office patients. This is the most frequently used code for these encounters. Internists selected this level of care for 47.41% of established office patients in 2014. The Medicare allowable reimbursement for this service is $108.13 and it is worth 1.5 work RVUs. Usually, the presenting problems are of moderate to high severity.
- Think 99214 in any of the following situations:
- If the patient has a new complaint with a potential for significant morbidity if untreated or misdiagnosed,
- If the patient has three or more old problems,
- If the patient has a new problem that requires a prescription,
- If the patient has three stable problems that require medication refills, or one stable problem and one inadequately controlled problem that requires medication refills or adjustments.
Established Patient E/M: 2 of 3 Key Components
Office/outpatient E/M codes for an established patient, 99212-99215, require a visit to meet only 2 of the 3 key components listed to support the service level. Following table shows the key component requirements for the different established patient office/outpatient E/M code levels.
|99211||(Usually, the presenting problems are minimal)|
|99212||Problem focused||Problem focused||Straightforward|
|99213||Expanded problem focused||Expanded problem focused||Low complexity|
Coding Office Visits – Based on Time
An E/M office visit may be coded based solely on face-to-face time when more than half is devoted to counseling or coordination of care. CPT requirements for history, exam, and medical decision making requirements do not have to be met. Be sure to document the total time spent and that more than half involved counseling or coordination of care, and describe the nature of the counseling or care coordination activities (e.g., “counseled patient regarding weight gain, daily food intake, and goal setting”). Choose your level of service according to CPT’s definitions of what is typical for each code.
|CPT Code||Typical Time|
REIMBURSEMENT FOR CPT CODE 99214
|CPT Code||Service Time||Medicare||Commercial|
|99212||10 minutes||$ 40.61||$ 90.00|
|99213||15 minutes||$ 68.10||$ 90.00|
|99214||25 minutes||$ 101.21||$ 90.00|
|99215||40 minutes||$ 136.57||$ 148.00|
* It’s important to note that CPT Code 99214 reimbursement rates vary by location, the insurance company, network status, panel, license, and more.
For accurate medical billing, knowing your CPT codes is the most important thing. In our blog series of ‘Know Your Codes’ or ‘KYC,’ we have discussed the most common CPT codes in detail and when to use them. E2E Medical Billing Services is known for it’s accurate and affordable medical billing services. To know more about our medical billing services call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com