Nephrology, coding reference.

99214 is the workhorse of primary care and most outpatient subspecialties. Use it when at least one of these is true: two or more chronic problems with progression, treatment changes, or side effects; one undiagnosed new problem with uncertain prognosis; one acute illness with systemic symptoms; or prescription drug management at any complexity. Prescription drug management on its own satisfies the moderate-risk element, which is why straightforward chronic disease follow-ups with a med adjustment routinely clear the 99214 bar. Time-based alternative is 30 to 39 minutes of total time on the date of the encounter. Pick the method that supports the strongest note: encounters with prescription changes are usually cleaner under MDM; encounters with extensive counseling or care coordination are usually cleaner under time.

Select this level when at least two of the three MDM elements meet high complexity, or when qualifying total time reaches 40 minutes. A diagnosis, medication, or high-risk decision alone does not establish the overall level. For Medicare prolonged services with this time-selected base code, the first G2212 unit requires 69 minutes. Payers recognizing CPT 99417 use different thresholds.

Pediatric ESRD <2 years, 4+ face-to-face dialysis visits in the calendar month.

Pediatric ESRD ages 2-11, 4+ face-to-face dialysis visits in the calendar month.

Adolescent ESRD ages 12-19, 4+ face-to-face dialysis visits in the calendar month.

Adult ESRD patient on chronic dialysis, 4+ face-to-face visits in the calendar month.

Adult ESRD with 2-3 face-to-face dialysis visits in the calendar month.

Adult ESRD with exactly 1 face-to-face dialysis visit in the calendar month.

Home dialysis monthly cap for pediatric patients under 2 years.

Per-diem ESRD billing when patient is not on chronic dialysis for the full month (e.g. transplant, hospitalization, death).