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. The CMS 2026 wRVU for 99214 is 1.92, the workhorse value in primary care. Medicare allowable is calculated using the national GPCI and the 2026 conversion factor of $33.4009.
The 2021 E/M guidelines let you bill 99214 by time or MDM. Here is the decision tree, with documentation templates for each method.
Modifier 25 carves an E/M out of a same-day procedure or preventive service. Here is when to use it, when to skip it, and the documentation that survives audit.
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.