CPT® code 99214 is used for an established patient office or outpatient visit that involves a moderate level of medical decision making or 30–39 minutes of total time spent on the date of service. This code falls under the Evaluation and Management (E/M) category and is among the most commonly billed office visit codes in the United States.
When to Use CPT 99214
Code 99214 applies when a physician or other qualified health professional sees an established patient and the visit requires:
- A medically appropriate history and/or examination, and
- Moderate complexity medical decision making (MDM), OR
- 30–39 minutes spent in direct and non-direct patient care activities on the same date (including reviewing records, documenting, and counseling).
Typical Patient Scenario
A 99214 visit often involves patients with:
- A chronic condition that is worsening (e.g., uncontrolled diabetes, COPD flare-up)
- A new but moderate-risk problem (e.g., chest pain requiring further evaluation, but not immediate hospitalization)
- A condition requiring prescription drug management or discussion of potential surgical options
Example: An established patient comes in for follow-up on hypertension that is not well-controlled despite medication adjustments. The physician reviews prior labs, orders additional tests, adjusts medications, and provides counseling on lifestyle changes.
Key Components of CPT 99214
1. Medical Decision Making (MDM)
For 99214, the provider must demonstrate moderate complexity MDM, which may include:
- Multiple diagnoses or management options
- Reviewing and/or ordering multiple tests
- Prescription drug management
- Evaluating risks of complications or morbidity
2. Time Requirement
If coding based on time instead of MDM:
- 30–39 minutes total time must be documented on the date of service
- Time includes reviewing patient records, documentation, ordering tests, communicating results, and patient counseling
Why 99214 Matters
CPT 99214 is often used in primary care, internal medicine, psychiatry, and specialty practices because many follow-up visits require more than a simple check-in but do not rise to the highest level of complexity (99215). It strikes a balance between common chronic care management and more intensive evaluation.
Compliance and Documentation Tips
- Clearly document medical necessity and decision making
- Record time spent if billing by time
- Include all relevant history, exam findings, and counseling provided
- Avoid upcoding (billing 99214 when criteria are not met) or undercoding (defaulting to 99213 for visits that qualify as 99214)
CPT Code Set and Updates
The AMA CPT Editorial Panel reviews and updates codes annually to reflect changes in clinical practice, digital health, and medical technology. Staying current ensures proper reimbursement and compliance with payer policies. Always confirm with the latest CPT® manual and payer-specific guidelines.
Final Takeaway
- CPT 99214 = Established patient, moderate complexity, 30–39 minutes
- Used for chronic disease management, prescription adjustments, and moderate-risk decisions
- Correct use depends on clear documentation of MDM or time