99213 vs. 99214: How to Choose the Right Office Visit Level

The difference between 99213 and 99214 is the level of medical decision making, or the time. 99213 needs low MDM or at least 20 minutes; 99214 needs moderate MDM or at least 30 minutes. In practice, the deciding factor is often whether the visit involved prescription drug management together with a chronic illness that is worsening or not at goal, or two or more chronic conditions.

99213 vs. 99214 side by side

Element	Low (99213)	Moderate (99214)
Problems addressed	2 or more self-limited or minor problems; or 1 stable chronic illness; or 1 acute, uncomplicated illness or injury; or 1 stable acute illness	1 or more chronic illnesses with exacerbation, progression or side effects of treatment; or 2 or more stable chronic illnesses; or 1 undiagnosed new problem with uncertain prognosis; or 1 acute illness with systemic symptoms; or 1 acute complicated injury
Data reviewed and analyzed	At least 1 of: any 2 of reviewing prior external notes, reviewing a test result, or ordering a test (each unique); or an assessment requiring an independent historian	At least 1 of: any 3 of the low-level data items (notes, test results, tests ordered, independent historian); or independent interpretation of a test performed by another provider; or discussing management or a test with an external physician or other appropriate source
Risk of patient management	Low risk of morbidity from further testing or treatment	Moderate risk, for example prescription drug management, or a decision about minor surgery with risk factors

	99213	99214
MDM level	Low	Moderate
Time on the date of the visit	20 minutes or more	30 minutes or more
Common example	One stable chronic illness, refill only	One chronic illness not at goal with a medication change
New patient equivalent	99203	99204

A quick way to decide

1. List the problems you addressed. Two or more chronic problems, or one that is worsening, points to moderate.
2. Look at the management decision. Prescription drug management makes risk moderate.
3. Count the data: three items such as notes reviewed, tests reviewed or ordered, or an independent historian, makes data moderate.
4. If 2 of the 3 elements are moderate, bill 99214. If not, check total time: 30 minutes or more also supports 99214.

Common mistakes

• Under-coding by habit: billing 99213 for every follow-up, even when two chronic conditions and medication changes were handled.
• Counting time that does not qualify: clinical staff time or time on a different day.
• Choosing by history and exam: since 2021 they do not set the level.
• Thin notes: the decision was moderate, but the note does not show the problem status or the reasoning.

Frequently asked questions

Which pays more, 99213 or 99214?

99214, because it describes more work. Check exact Medicare amounts in the CMS Physician Fee Schedule look-up tool (opens in a new tab).

Should I code by MDM or by time?

Whichever supports the higher level for that visit, as long as the note documents it. Time often helps for counseling-heavy visits; MDM helps for complex but quick visits.

Related guides

• CPT 99213: low-complexity established visit
• CPT 99214: moderate-complexity established visit
• CPT 99215: high-complexity established visit
• CPT 99204: moderate-complexity new patient visit
• CPT 99203: low-complexity new patient visit
• CPT 99205: high-complexity new patient visit
• CPT 99212: straightforward established visit
• CPT 99202: straightforward new patient visit
• CPT 99211: nurse visit for an established patient
• CPT 99417: prolonged office visit add-on
• Primary care billing services
• Medical coding services

CPT is a registered trademark of the American Medical Association. This guide summarizes the office visit E/M rules in effect since 2021, with the 2024 time wording, and the CMS Evaluation and Management Services guide (MLN006764) (opens in a new tab). Payer policies and your documentation decide what is billable.