February 21, 2025
CPT code 99214 is one of the most commonly used procedure code for installed patient office trips. However, it is also most often incorrectly informed. Claims to ensure proper documentation and billing practices can help avoid denials and potential audits.
In this guide, we will cover everything required to know about the process code 99214, including its requirements, compared with other codes like 99204 and 99213, and best practices for accurate billing.
Many providers struggle with selection between process codes 99214 and process code 99213. The main difference is the level of complexity:
Claiming to use 99214 incorrectly can result in a result of refusal or overbilling concerns, which is why accurate documents are required.
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 code 99214, at least two of the following three elements must be of moderate complexity:
Unlike 99214, 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:
Billing CPT code 99214 is required properly to avoid denying and ensure accurate reimbursement. Understanding the requirements of time and medical decision-making, the provider can confidently choose the right code for each visit.
Always ensure that documentation supports the level of services billed to remain compliant and maximize revenue.
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