Guide the 99214 CPT code: description and guidelines

CPT code 99214 is utilized to invoice an established patient for a level 4 E/M visit, encompassing medically necessary history and examination coupled with moderate decision-making.

Description of the 99214 CPT code

• History: It should be comprehensive and appropriate for the patient’s presentation.
• Examination: It should assess the patient’s condition and identify any relevant physical findings that are medically appropriate for their presentation.
• Medical decision-making: Provider must analyze various diagnostic and therapeutic options to make moderate decisions for patient care.
• Time: It involves direct face-to-face time with the patient for 25 minutes.

When should CPT code 99214 be used?

Level 4 E/M visit for an established patient indicates that visit meets at least two key components mentioned above. It is appropriate for various scenarios, such as a patient presenting with new symptoms like chest pain. Provider considers several diagnostic and/or therapeutic options, such as ordering additional tests, referring patient to a specialist, or prescribing medication.

How to code CPT code 99214

Healthcare provider needs to document patient’s medical history, physical exam, medical decision-making process, and total time spent. If provider spends more than 30 minutes with patient, with over half the time dedicated to counseling or coordinating care, this code may be assigned based on time.

How much is the 99214 reimbursement rate for 2023?

 The reimbursement rate in Los Angeles increased to $196.29 due to the CMS updating the 2023 conversion factor to $33.8872 in response to a 2% Medicare physician payment cut implemented in 2023.

Does Medicare cover CPT 99214?

Yes, but if a visit does not meet these criteria, Medicare may not cover it.