99214 Established patient office visit, moderate complexity

What to know

• Time threshold: 30 minutes or more of total practitioner time on the date of the visit.
• Moderate MDM usually means things like a chronic illness that's getting worse, two or more stable chronic illnesses, or prescription drug management.
• Since 2021, history and exam don't set the level. They still need to be medically appropriate and documented.

Related codes

• 99213 Established patient office visit, low complexity CPT
• 99215 Established patient office visit, high complexity CPT
• 99204 New patient office visit, moderate complexity CPT
• G2211 Visit complexity inherent to evaluation and management associated with medical care… HCPCS

Common questions

How much time is required for 99214?

When coding by time, 99214 requires 30 minutes or more of total practitioner time on the date of the visit. That includes non-face-to-face work such as reviewing records and documenting.

What's the difference between 99214 and 99215?

99214 is moderate-complexity medical decision making (or 30+ minutes). 99215 is high-complexity MDM (or 40+ minutes).

Can G2211 be billed with 99214?

Medicare allows the G2211 add-on with office E/M visits like 99214 when the practitioner is the continuing focal point for the patient's care or manages a serious or complex condition over time. Check payer policy.