At Billing Care Solutions, we help healthcare providers bill 99214 accurately, reduce denials, and stay compliant with current CMS guidelines. This guide explains when to use CPT code 99214, documentation requirements, and common billing mistakes to avoid.

What Is CPT Code 99214?

CPT code 99214 describes an office or other outpatient visit for the evaluation and management of an established patient that requires moderate medical decision making (MDM) or qualifying provider time.

Key Features of 99214:

• Established patient

• Office or outpatient setting

• Moderate complexity

• Commonly used for chronic condition management

CPT Code 99214 Billing Requirements (2021+ E/M Rules)

Under updated E/M guidelines, CPT code 99214 is selected based on either:

• Medical Decision Making (MDM)
  OR

• Total time spent by the provider on the date of the encounter

History and physical exam are documented as medically appropriate, not level-driven.

Medical Decision Making for CPT Code 99214

To bill 99214 using MDM, two of the following three elements must meet the moderate level:

1. Number and Complexity of Problems Addressed

Examples:

• Two or more stable chronic illnesses

• One chronic illness with exacerbation or progression

• One undiagnosed new problem with uncertain prognosis

2. Amount and/or Complexity of Data Reviewed

Examples:

• Review of multiple lab or imaging results

• Ordering diagnostic tests

• Reviewing external medical records

3. Risk of Complications and/or Morbidity

Examples:

• Prescription drug management

• Decision regarding minor surgery with risk factors

• Ongoing management of chronic conditions

Time-Based Billing for CPT Code 99214

CPT code 99214 can also be billed based on total provider time.

Time Range:

⏱ 30–39 minutes

Time includes:

• Reviewing patient records

• Face-to-face and non-face-to-face patient care

• Counseling and education

• Ordering tests or medications

• Documentation

CPT Code 99214 vs 99213

Billing 99214 instead of 99213 must be fully supported by documentation.

Common Specialties Using CPT Code 99214

• Family Medicine

• Internal Medicine

• Cardiology

• Endocrinology

• Neurology

• Psychiatry

• Pain Management

Because of its frequent use, CPT code 99214 is considered a high-audit-risk code.

Common Billing Errors with CPT Code 99214

At Billing Care Solutions, we commonly see:

• Upcoding without adequate documentation

• Insufficient explanation of moderate MDM

• Incomplete time documentation

• Overuse of 99214 for routine visits

• Copy-and-paste notes lacking medical necessity

These errors often lead to downcoding or denials.

How Billing Care Solutions Can Help

Billing Care Solutions offers expert medical billing and coding services, including:

• E/M coding audits

• Documentation improvement support

• Denial management and appeals

• Compliance-focused billing

• Full revenue cycle management

Our experienced billing professionals ensure CPT code 99214 is used correctly, compliantly, and profitably.

Final Thoughts

The 99214 CPT code reflects moderate-complexity care for established patients and plays a critical role in practice revenue. Proper documentation and adherence to CMS guidelines are essential to avoid denials and audits.

If your practice is struggling with 99214 denials or E/M coding accuracy, Billing Care Solutions is here to help.

? Visit billingcaresolutions.com to learn more about our medical billing services.