October 9, 2025
99214 CPT Code Overview
The 99214 CPT code is one of the most frequently used evaluation and management (E/M) codes for established patients during an office or other outpatient visit for the evaluation and management of an established patient that requires moderate medical decision-making.
It represents encounters that involve moderate risk and a higher level of clinical complexity compared to routine visits. Accurate documentation of patient care, coordination, and the total time spent during the visit is essential to ensure proper code selection and compliance with payer guidelines.
In this guide, we will cover everything you need to know about the process code 99214, including its requirements, comparisons with other codes like 99204 and 99213, and best practices for accurate medical billing.
The CPT 99214 code applies when the encounter involves moderate risk and requires detailed evaluation and management. Many healthcare providers find it challenging to distinguish between procedure codes 99213 and 99214.
The key difference lies in the complexity and time required:
Selecting the correct code depends on the provider’s documentation, the risk level, and the total time spent managing the patient’s condition. Over-coding or under-coding can lead to compliance issues or revenue loss.
One way to justify CPT code 99214 is to document the total time spent with the patient on the day of travel. By 2024, the minimum required time for billing 99214 is 30 minutes.
This includes:
If the total time spent is less than 30 minutes, procedure code 99213 should be used instead.
For procedure 99214 CPT Code, at least two of the following three elements must be of moderate complexity:
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Since 2025, providers must document either medical decision-making (MDM) of moderate complexity or a minimum of 30 minutes of total patient care time on the date of service to bill CPT 99214 correctly.
This may include reviewing diagnostic tests, prescribing medication, managing chronic conditions, or educating the patient about treatment options. Properly supporting the level of MDM and time spent ensures accurate reimbursement and minimizes claim denials during office or other outpatient visits.
99214 CPT Code, which are for established patients, 99204 CPT codes are used for new patient visits that require moderate complexity in MDM. The key differences are:
Here are some common errors that lead to denied claims or audits:
To ensure compliance and proper reimbursement when billing CPT code 99214, follow these guidelines:
Properly documenting and billing the 99214 CPT code is crucial for accurate reimbursement and compliance. By meeting the required criteria for moderate risk, total time, and medical decision-making, healthcare providers can ensure appropriate compensation for their services while maintaining transparency in patient care.
Partnering with experienced medical billing professionals can further streamline the evaluation and management process, reduce denials, and strengthen revenue integrity for office or other outpatient visits.
CPT code 99214 is an evaluation and management (E/M) code for an established patient office visit requiring moderate medical decision-making or 30 minutes of total time.
Code selection depends on complexity. Use 99213 for low-level visits and 99214 when the visit includes moderate medical decision-making or 30+ minutes spent.
Moderate complexity involves multiple or worsening problems, complex test reviews, or prescription drug management. It supports accurate coding and documentation.
You can bill 99214 based on either medical decision-making or time (at least 30 minutes). Both require thorough documentation to support the claim.
Yes. As long as the visit meets office or other outpatient visit criteria and includes proper documentation, 99214 can apply to virtual care too.
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