CPT 99214 is the established-patient office visit for moderate medical decision making, or 30 minutes or more of total practitioner time on the date of service.
It is the workhorse code of chronic-care medicine, and that is exactly why payers audit it closely. A 99214 billed for a visit that only supports 99213 is an overpayment. A 99213 billed for a visit that supports 99214 is revenue your practice never collects.
Either error usually traces back to one of three gaps: counting problems that were not actually addressed, billing by time without a time statement, or relying on the data element when the note does not list what was reviewed.
This guide covers the exact 2026 criteria, a note that supports 99214, payment, G2211, modifiers, telehealth rules and the errors that cause denials or downcoding.
Key Takeaways
- 99214 requires moderate MDM, meaning two of three elements (problems, data, risk) at the moderate level, or at least 30 minutes of total time on the date of service.
- Since the 2024 CPT update, time thresholds are minimums: 30 minutes for 99214 and 40 minutes for 99215.
- The 2026 national Medicare amount is about $135.61 non-facility and $84.50 facility, before local adjustment.
- Medicare’s G2211 add-on can be reported for longitudinal care, but not with modifier 25 except alongside an AWV, vaccine administration or a Part B preventive service.
- Medicare’s home-based and audio-only telehealth flexibilities run through December 31, 2027.
99214 at a Glance
| Item | Rule for 99214 |
|---|---|
| Patient type | Established: seen by the same physician or a same-specialty group member within the past 3 years |
| Level by MDM | Moderate: two of three MDM elements at the moderate level |
| Level by time | 30 minutes or more of total practitioner time on the date of the encounter |
| 2026 Medicare | About $135.61 non-facility and $84.50 facility (4.06 and 2.53 total RVUs, non-QP conversion factor $33.4009) |
| Common add-on | G2211 for longitudinal care (Medicare) |
| Neighbouring codes | 99213 (low MDM, 20+ minutes) and 99215 (high MDM, 40+ minutes) |
Choosing 99214 by Medical Decision Making
MDM has three elements. To reach moderate MDM, two of the three must be met or exceeded.
1. Problems addressed (moderate)
- One or more chronic illnesses with exacerbation, progression or side effects of treatment
- Two or more stable chronic illnesses
- One undiagnosed new problem with uncertain prognosis
- One acute illness with systemic symptoms
- One acute complicated injury
A problem counts only if it was addressed, meaning evaluated or treated at this visit. A diagnosis listed in the history but not managed does not count.
2. Data reviewed and analyzed (moderate)
Meet one of three categories:
Category 1: any three of: review of prior external notes from each unique source; review of the result of each unique test; ordering of each unique test; assessment requiring an independent historian.
Category 2: independent interpretation of a test performed by another physician or qualified health professional, not separately reported.
Category 3: discussion of management or test interpretation with an external physician or appropriate source, not separately reported.
3. Risk of patient management (moderate)
- Prescription drug management: starting, stopping, adjusting, or deciding to continue a drug after review
- Decision regarding minor surgery with identified patient or procedure risk factors
- Decision regarding elective major surgery without identified risk factors
- Diagnosis or treatment significantly limited by social determinants of health
Most 99214 visits qualify through problems plus risk, for example two stable chronic conditions with prescription drug management. Do not rely on the data element unless the note clearly lists each test and outside note reviewed.
Choosing 99214 by Time
Count only the practitioner’s own time, face-to-face and non-face-to-face, on the calendar date of the encounter.
| Counts | Does not count |
|---|---|
| Preparing for the visit | Clinical staff time |
| History, exam and counseling | Travel time |
| Ordering tests, drugs or referrals | Time spent on separately billed services |
| Same-day documentation | Work done on a different date |
Example time statement: “I spent 34 minutes on the date of this encounter reviewing labs, examining the patient, adjusting medications and documenting.”
99213 vs 99214 vs 99215
| Code | MDM level | Minimum time | Typical example |
|---|---|---|---|
| 99213 | Low | 20 minutes | One stable chronic illness, refill without change |
| 99214 | Moderate | 30 minutes | Two stable chronic illnesses with a prescription adjustment |
| 99215 | High | 40 minutes | Severe exacerbation needing a decision about hospitalization |
Seeing a new patient instead? Use our CPT 99203 new patient guide. For inpatient follow-up, see the 99233 subsequent hospital care guide.
Documentation Example That Supports 99214
A 62-year-old established patient with type 2 diabetes and hypertension returns for follow-up.
| Element | What the note shows | Level |
|---|---|---|
| Problems | Type 2 diabetes with A1c up from 7.1% to 8.2% (chronic illness with progression); hypertension, controlled | Moderate |
| Data | Reviewed A1c and basic metabolic panel; ordered urine albumin-to-creatinine ratio (three unique tests) | Moderate |
| Risk | Increased metformin; continued lisinopril after reviewing potassium and creatinine | Moderate |
All three elements reach moderate, so the visit supports 99214. It would still qualify without the data, because problems and risk alone meet two of three. Diagnoses: E11.65 (type 2 diabetes with hyperglycemia) and I10 (essential hypertension).
Billing G2211 With 99214
Medicare’s add-on code G2211 recognizes the work of being the continuing focal point for a patient’s care, or of providing ongoing care for a single serious or complex condition. It can be added to office and outpatient E/M codes 99202 to 99215, and from January 1, 2026 also to home and residence visit codes 99341 to 99350.
- Show the ongoing relationship in the note, for example that you manage the patient’s chronic conditions over time.
- Check each commercial payer’s policy, because many do not recognize G2211.
Do not add G2211 when the E/M carries modifier 25, unless the other same-day service is an annual wellness visit, vaccine administration or a Medicare Part B preventive service. For the vaccine product and administration codes, see our shingles vaccine CPT code guide.
Modifiers Commonly Used With 99214
| Modifier | When to use it | What the note must show |
|---|---|---|
| 25 | Significant, separately identifiable E/M on the same day as a minor procedure or other service | Work beyond the usual pre- and post-procedure evaluation |
| 24 | Unrelated E/M during a postoperative global period | A diagnosis and plan unrelated to the surgery |
| 57 | The E/M resulted in the decision for major surgery | The surgical decision documented at this visit |
| 95 | Synchronous audio-video telehealth (payer-specific) | Modality, locations and consent |
| 93 | Audio-only telehealth where the payer allows it | That the visit was audio-only and why video was not used |
Modifier problems are a leading cause of rejected E/M claims. See our guides to CO-4 modifier denials and CO-97 bundling denials.
Billing 99214 for Telehealth in 2026
99214 can be billed for telehealth when the visit meets the same MDM or time criteria as an in-person visit. For Medicare, the Consolidated Appropriations Act, 2026 extended the home-as-originating-site and audio-only flexibilities through December 31, 2027.
- Choose the place of service. Use POS 10 when the patient is at home and POS 02 when the patient is elsewhere.
- Add the right modifier. Use modifier 93 for audio-only visits, and check whether the payer requires modifier 95 for audio-video.
- Document the visit. Record the modality, the patient’s and provider’s locations, and consent.
Behavioral health practices should also read our telehealth mental health CPT codes guide.
Common 99214 Errors That Cause Denials or Downcoding
Counting problems that were not addressed. Listing six diagnoses does not raise MDM if only one was managed.
Calling a simple refill “prescription drug management”. The note must show the drug was reviewed against the patient’s current status.
Billing by time without a time statement, or counting staff time or time from another date.
Using 99214 for a new patient who has not been seen by the group’s same-specialty physicians in the past 3 years.
Weak diagnosis specificity, which can trigger a CO-11 diagnosis mismatch denial.
Cloned notes that repeat the same text visit after visit, a common audit red flag.
Get Your E/M Levels Right
Undercoding 99214 visits as 99213 quietly costs a busy practice thousands of dollars a year, while overcoding invites audits. To see how CPT, ICD-10 and HCPCS work together, read understanding CPT, ICD-10 and HCPCS codes.
Want certified coders to check your E/M levels against current AMA and CMS rules? Explore Steady Medical Billing’s medical coding services.
Frequently Asked Questions
How many minutes is a 99214 visit?
When coding by time, 99214 requires at least 30 minutes of total practitioner time on the date of the encounter. At 40 minutes, the visit qualifies for 99215.
What MDM is required for 99214?
Moderate medical decision making: two of the three MDM elements (problems, data, risk) must reach the moderate level. The most common combination is two stable chronic illnesses plus prescription drug management.
How much does Medicare pay for 99214 in 2026?
The 2026 national Medicare amount is about $135.61 in a non-facility setting and $84.50 in a facility setting, before geographic adjustment. Your local rate will differ.
Can I bill G2211 with 99214?
Yes, for Medicare, when you are the continuing focal point of the patient’s care or manage a serious or complex condition over time. It is not payable with modifier 25 except alongside an annual wellness visit, vaccine administration or a Part B preventive service.
Can 99214 be billed for telehealth?
Yes. Use POS 10 for a patient at home or POS 02 elsewhere, add modifier 93 for audio-only visits, and document modality, locations and consent. Medicare’s home and audio-only flexibilities run through December 31, 2027.
