99214

E/M EstCMS status: A

Office or other outpatient visit, established patient, moderate-level MDM or 30-39 minutes total time.

Outpatient IM Cardiology Endo GI Pulm Nephro Rheum ID Heme/Onc Neurology Allergy Geri / CCM

Work RVU

1.92

Practice RVU

2.00

Malpractice RVU

0.14

Total RVU

4.06

2026 Medicare payment

$135.61

National GPCI = 1.000 · Conversion factor $33.4009 · Non-facility

Model this code

Drop 99214 into a scenario to see how unit volume rolls up to annual wRVUs, gross collections, and bonus.

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When to use it

The workhorse code. Two or more chronic problems with progression/treatment changes, OR one undiagnosed new problem with uncertain prognosis, OR prescription drug management.

Documentation checklist

✓MDM: moderate complexity — meet 2 of 3 elements (problems, data, risk).
✓Risk: prescription drug management is sufficient to hit moderate risk by itself.
✓Data: review of external notes + ordering tests + independent interpretation each count as separate categories.
✓Time-based alternative: 30-39 minutes total time on date of encounter, documented.

Common pitfalls

!Counting your own labs/imaging as 'external' data — those don't count.
!Calling a 99214 'moderate complexity' without prescription management or a problem with uncertain prognosis.
!Not documenting independent interpretation when reviewing outside images.

Common modifiers

2595

Common ICD-10 pairings

E11.9I10I50.32N18.4