This document provides a comprehensive guide on CPT code 99214, which pertains to moderate complexity outpatient visits for established patients. It outlines the requirements for proper billing, including detailed history, examination, and decision-making, along with key considerations for maximizing reimbursement. The average Medicare reimbursement rate for 99214 in 2024 is $126.07, while Medicaid is $68.97.

1. Mastering CPT Code
99214: A Guide for
Medical Coders
This presentation will guide you through the complexities of CPT code
99214, helping you maximize reimbursement and ensure accurate
billing.

2. What is CPT Code 99214?
Level 4 Office Visit
Represents a moderate complexity outpatient visit for
established patients.
Evaluation and Management (E/M)
Used to describe services involving extensive history,
comprehensive examination, and moderate medical
decision-making.

3. 99214 Requirements:
Ensuring Compliance
1 Detailed Problem-
Focused History
A thorough review of the
patient's current and past
medical history.
2 Problem-Focused
Examination
A comprehensive
assessment of the patient's
affected systems.
3 Moderate Complexity Decision-Making
Evaluation of multiple management and diagnostic options,
considering risks and complications.

4. Rules of Thumb for 99214
Untreated Condition
Use 99214 when a patient's
condition, if left untreated,
could lead to morbidity.
Pre-Existing
Conditions
Consider 99214 when a
patient has three or more pre-
existing conditions.
New Ailment
Use 99214 when a patient presents with a new ailment requiring a
prescription.

5. How to Assign CPT Code 99214
Review Documentation
Ensure the medical record supports the
billed service, including patient history,
examination, and medical decision-
making.
Assess Complexity
Evaluate the complexity of the patient's
medical issue to determine if 99214 is
appropriate.
Consider Time Spent
If more than half of the visit was spent
on counseling or coordinating care,
use time to justify the level of service.

6. CPT Code 99214
Reimbursement
$126.07
Medicare
Average reimbursement rate for
CPT code 99214 in 2024.
$68.97
Medicaid
Average reimbursement rate for
CPT code 99214 in 2024.

7. Associated Codes
Code Decision-Making Encounter Time (mins)
99213 Low 20-29
99214 Moderate 30-39
99215 High 40-54

8. Key Takeaways
1 Accurate Documentation
2 Understanding Requirements
3 Maximize Reimbursement
By understanding the requirements and nuances of CPT code 99214, you can ensure accurate billing and maximize
reimbursement for your practice.

9. Key Considerations for CPT Code 99214
Accurate documentation is crucial for successful CPT code 99214 billing.
Ensure compliance with requirements regarding history, examination, and medical decision-making.
Maximize reimbursement by thoroughly understanding the code's nuances.
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