99214
Office o/p est mod 30 min
Office or other outpatient visit, established patient, moderate-level medical decision making OR 30-39 minutes of total time on the date of the encounter.
Published by RVUDoc. Numeric data: CMS RVU26C, effective 2026-07-01. Page updated 2026-09-23. Calculation limits and editorial policy.
Fee-schedule estimate before claim adjustments. Coverage, setting and payer rules still apply.
Compare 99213 and 99214 using qualifying time or documented MDM. See a worked example and try the free guided E/M tool.
Review the separately identifiable E/M requirement, supporting documentation and payer limits for modifier 25.
Billing guidance for 99214 is locked
- When to use it: the exact clinical situations that support billing 99214
- Documentation checklist: the 6 elements your note needs before submitting
- Common pitfalls: the 6 mistakes that get 99214 downcoded or denied
Payer notes
Medicare audits the 99213-to-99214 ratio at the clinician and practice level. Commercial payers vary: UnitedHealthcare and Anthem occasionally apply post-payment reviews on 99214 when prescription management is not clearly documented. Medicare Advantage plans typically follow Medicare guidelines. For telehealth, use POS 10 (home) or POS 02 (other) with modifier 95; some commercial payers require POS 11 with modifier 95.
Related codes
These include alternative services and possible add-ons. Listing codes together does not establish that they can be billed together; check the applicable edits and payer policy.
See what 99214 adds to your year
Add it to the wRVU calculator with your own volume, or paste a note and let the chart audit check your coding.