What is the CPT code 99214 for insurance?
Asked by: Ernestine Rogahn | Last update: August 1, 2025Score: 4.3/5 (33 votes)
What is the CPT code 99214 billing guideline?
CPT code 99214 is indicated for established patient visits that involve a detailed history, comprehensive examination, and moderate-level medical decision-making. You can code 99214 based on time if you spend half of the patient's visit counseling or coordinating care, and have a total visit time of 30-39 minutes.
What level of visit is a 99214?
The total time needed for a level 4 visit with an established patient (CPT code 99214) is 30–39 minutes. The total time needed for a level 4 visit with a new patient (CPT 99204) is 45–59 minutes. Many EHRs have time calculators that will show the amount of time you have had the patient's chart open.
Is CPT code 99214 preventive?
CPT 99214 should be used for moderately complex cases, such as managing chronic conditions or treating an acute illness that requires adjustments to treatment plans, like medication changes or further diagnostic testing.
When to bill preventive visit with office visit?
CPT states that if a new or existing problem is assessed and managed at the time of the preventive visit, the physician should also bill a problem-oriented visit (an office visit) on the day of the preventive care.
Medical Decision Making with CPT Code 99214
What is the difference between 99213 and 99214?
The primary difference between CPT code 99213 and 99214 lies in the complexity and time involved. While 99213 is for a low level of medical decision-making, 99214 is used for moderate complexity, requiring a higher level of medical decision-making and more extensive history and examination.
How much does Medicare pay for a doctor's office visit?
Another thing to keep in mind is Medicare-approved amounts vary from state to state. In Los Angeles, California, the Medicare-approved amount for those same office visits ranges from $89.73 to $243.48.
How many times a year can you bill 99214?
If a physician performs more than two high complex visits (99214 or 99215) in a year the MCO has the responsibility to reduce the reimbursement to the payment rate for CPT 99213, without changing the CPT code or asking the physician to change the CPT code.
What is the CPT code for primary care visit?
Primary care CPT codes 99211-99215 and 99202-99205 are used to bill for evaluation and management services provided in an office or other outpatient setting.
What is the CPT code for an annual wellness visit?
AWV Coding. The CPT codes for Annual Wellness Visits are G0438 for the initial visit and G0439 for subsequent visits. These codes are used to bill Medicare for comprehensive wellness assessments and personalized prevention plans. It is important to remember that code G0438 is for the first AWV only.
What is considered an office visit?
An office visit is any direct personal exchange between an ambulatory patient and a physician or members of their staff for the purpose of seeking care and rendering health services.
What qualifies a 99214?
According to CPT, 99214 is indicated for an “office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history, a detailed examination and medical decision making of moderate complexity.” [For more detailed ...
Can you bill an office visit and hospital visit on the same day?
CPT Codes 99221-99223, 99231-99236, 99238 & 99239
MACs pay both visits if you see a patient in the office on 1 day, and they're admitted to the hospital as an inpatient or get observation care on the next day.
Is 99214 a mental health code?
The appropriate E/M code would be 99214 (office or outpatient service for an established patient), based on the 25-minute time rather than on a detailed history and examination and moderately complex medical decision making that would be required to use this code if counseling and coordination had not taken up more ...
Can a doctor bill you 4 years later?
In most states, the statute of limitations to collect on unpaid medical bills is between three and six years. However, in some states, a creditor has between 10-15 years to try and collect on the debt. In the table below, we've outlined the statute of limitations on medical debt in every state.
What does CPT stand for?
The Current Procedural Terminology (CPT®) codes offer doctors and health care professionals a uniform language for coding medical services and procedures to streamline reporting, increase accuracy and efficiency.
How many doctor visits does Medicare cover for seniors?
Medicare does not limit the number of times a person can consult their doctor, but it may limit how often they can have a particular test and access other services. Individuals can contact Medicare directly at 800-MEDICARE (800-633-4227) to discuss physician coverage in further detail.
Does everyone have to pay $170 a month for Medicare?
Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.
When not to use modifier 25?
Modifier 25 should not be used when: ❌ The sole purpose of the encounter is for the procedure (e.g., lesion removal), and there is no documented medical necessity for a separate E/M service.
What is a level 3 doctor visit?
Level-III visits are considered to have a low level of risk. Patient encounters that involve two or more self-limited problems, one stable chronic illness or an acute uncomplicated illness would qualify.
What diagnosis can be billed with 92133?
CPT code 92133 is designated for computerized ophthalmic imaging of the optic nerve. This procedure involves the use of advanced imaging technology to capture detailed images of the optic nerve, which is crucial for diagnosing and monitoring conditions such as glaucoma and other optic nerve disorders.