CPT 99214: Established Patient Office Visit, Moderate Complexity

CPT 99214 is an office or outpatient visit for an established patient that requires a moderate level of medical decision making, or at least 30 minutes of the provider’s total time on the date of the visit. Visits that involve prescription drug management or more than one chronic condition often qualify.

CPT 99214 description

99214 is an established patient office or other outpatient visit with a medically appropriate history and/or examination and a moderate level of medical decision making. When time is used to choose the level, 30 minutes must be met or exceeded. Like every office visit level since 2021, it is chosen by MDM or by time, whichever better supports the visit.

Office visit levels at a glance

Code	Medical decision making	Or total time on the date of the visit
99211	Not required (usually clinical staff)	Not used
99212	Straightforward	10 minutes or more
99213	Low	20 minutes or more
99214	Moderate	30 minutes or more
99215	High	40 minutes or more

Moderate medical decision making: what supports 99214

Two of the three MDM elements must reach moderate:

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

Typical 99214 visits

• Diabetes with an A1c above goal, where the medication dose is changed (a chronic illness with progression, plus prescription drug management).
• Two stable chronic conditions managed together, with prescriptions renewed or adjusted.
• A new problem with an uncertain outcome that needs a workup, such as a new breast lump with imaging ordered and external notes reviewed.
• An acute illness with systemic symptoms, such as pneumonia treated with a prescription.

Documentation that supports 99214

• Each problem addressed and its status (stable, worsening, not at goal)
• Tests ordered or reviewed, notes reviewed, and who provided history if not the patient
• The management decision and why, for example the medication started, stopped or changed
• Or the total time on the date of the visit, if time is used

Billing 99214 by time

Count the practitioner’s total time on the date of the visit, including:

• Preparing to see the patient, such as reviewing tests
• Getting or reviewing separately obtained history
• Performing a medically appropriate exam
• Counseling and educating the patient, family or caregiver
• Ordering medications, tests or procedures
• Referring and communicating with other professionals (when not separately reported)
• Documenting in the record
• Independently interpreting results (when not separately reported) and coordinating care

At 40 minutes or more, the visit meets the time for 99215. Medicare’s prolonged service code G2212 applies only beyond the 99215 time range.

Frequently asked questions

Does prescription drug management always mean 99214?

No. It makes the risk element moderate, but a second element, problems or data, must also reach moderate. Renewing a medication for one stable chronic illness is usually still 99213.

Is 99214 an audit risk?

Payers compare your level distribution with your peers. 99214 is appropriate when the note supports it; the protection is clear documentation of the problems, data and management decisions.

Related guides

• CPT 99213: low-complexity established visit
• 99213 vs. 99214: how to choose the level
• 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.