99213 vs 99214: Time and MDM Explained for 2026
For established office patients, 99213 corresponds to low MDM or at least 20 qualifying minutes; 99214 corresponds to moderate MDM or at least 30 qualifying minutes. Choose a supported method, not a target code.
Time: count eligible work
Count qualifying physician or QHP work on the date of service. Exclude staff time and separately reported services. Meet the threshold; do not round 29 minutes up to 30.
MDM: two of three elements
Assess problems addressed, eligible data reviewed/analyzed, and management risk. At least two elements must support the level. Prescription management alone does not establish moderate overall MDM.
A documentation example
An established-patient encounter with 25 qualifying minutes does not meet the 99214 time threshold. It may still support 99214 if documented MDM independently meets moderate complexity. These are alternative selection methods, not points to add together.
Make the reasoning visible
Identify your selection method. A long note, copied diagnosis list, or unchecked template cannot substitute for the care actually provided.
Frequently asked questions
Do I need both 30 minutes and moderate MDM?
No. Either method may support 99214 when the applicable requirements are met.
Does a refill automatically mean 99214?
No. Overall MDM needs two of three elements, or a separately supported time-based selection.
Related code pages
Sources and next steps
Source links checked 2026-09-23. RVUDoc editorial reference; not an independently certified coding review.
Try the guided E/M tool ↗Educational reference, not billing or legal advice. Verify against payer contracts and your compliance team before claim submission. Last updated 2026-09-23.