CPT Code 99214: Office Visit, Established Patient (Moderate Complexity)
Reviewed against AMA CPT and CMS guidance. See sources.
What is CPT 99214?
CPT 99214 is an office or outpatient visit for an established patient with moderate medical decision making, or at least 30 minutes of total time on the date of the visit. Psychiatric prescribers often use it for medication changes, side effect management, or several conditions. Same-day psychotherapy is added with 90833, 90836, or 90838.
E/M office visit for an established patient with moderate medical decision making. In psychiatry, used for medication management involving changes, new prescriptions, side effect assessment, or coordination of several medications.
Time Requirements
Moderate medical decision making, or at least 30 minutes of total clinician time on the date of the encounter. Psychotherapy time billed the same day cannot count toward E/M time.
Modifiers
| Code | Description |
|---|---|
| 25 | Significant, separately identifiable E/M service on the same day as a procedure. Payer requirements vary when billing E/M with a psychotherapy add-on. |
| 95 | Synchronous audio-video telehealth. Many payers also require a telehealth place of service code (02 or 10). |
| 93 | Synchronous audio-only service, where the payer allows audio-only care. |
Billing a session by video or phone? See telehealth modifiers 95, 93, GT and POS 02 vs 10.
When to Use
- Medication adjustments or new prescriptions for psychiatric conditions
- Evaluation of medication side effects that require decisions
- Management of several psychiatric conditions or medications
- With a psychotherapy add-on (90833, 90836, 90838) when both services are documented separately
When Not to Use
- Visits where overall decision making is low: use 99213
- Initial evaluations: use 90791 or 90792, or a new-patient E/M code (99202 to 99205) when appropriate
- Therapy by clinicians who do not bill E/M
- On the same day as 90791 or 90792 by the same clinician
What to Document for CPT 99214
- Problems addressed and their status (for example a chronic illness with side effects of treatment)
- Data reviewed and ordered
- Medication decisions, including prescription drug management
- Total time, if the level is chosen by time
- If psychotherapy was added, a separate psychotherapy section with its own minutes
Common Denial Reasons
- Documentation does not support moderate decision making (downcoded to 99213)
- Missing documentation of medication review or decisions
- Time-based level that counts psychotherapy minutes
- Psychotherapy billed as 90834 instead of add-on 90836 on the same day
Payer Notes
Document the elements of moderate decision making: the problems addressed, data reviewed, and risk of management, such as prescription drug management. Payer rules on modifier 25 with psychotherapy add-ons vary.
ICD-10 diagnosis codes
Every claim pairs the CPT code with the diagnosis the clinician documented. See the mental health ICD-10 code reference or a condition guide:
Related Codes
Frequently Asked Questions
Can I bill 99214 with 90834 on the same day?
Not as 90834. When the same clinician provides an E/M service and 38 to 52 minutes of psychotherapy on the same day, report 99214 with add-on 90836. Each service must be documented separately, and psychotherapy time must exclude E/M time.
What makes a medication visit a 99214?
Moderate decision making requires two of three elements: problems, data, and risk. In the CPT table, prescription drug management is an example of moderate risk, and a chronic illness with exacerbation or side effects of treatment, or two or more stable chronic illnesses, is a moderate problem level.
What counts toward the 30 minutes?
Total time by the billing clinician on the date of the encounter, face-to-face and not, such as reviewing records, documenting, and coordinating care. Time spent on separately billed psychotherapy is excluded.
When should I use 99213 instead?
When decision making is low and total time is under 30 minutes. Note that prescription drug management, even continuing the same medication, counts as moderate risk, so many medication visits meet the risk element for 99214.
Sources: American Medical Association (AMA), CPT Professional codebook: code descriptors, psychotherapy time rules, and add-on code guidance. Centers for Medicare & Medicaid Services (CMS): Medicare Physician Fee Schedule and National Correct Coding Initiative (NCCI) policy.
- AMA: CPT overview
- CMS: National Correct Coding Initiative (NCCI) edits
- CMS Medicare Coverage Database: Billing and Coding, Psychiatry and Psychology Services (A57480)
- CMS: Physician Fee Schedule relative value files
- CMS MLN901705: Telehealth and Remote Monitoring (PDF)
Payer rules vary. Confirm coverage, time, modifier, and documentation rules with each payer before billing. This page is general education, not billing or legal advice.
Write documentation for CPT 99214 sessions faster
Spend less time on documentation and more time with clients. You review every note before it is used for billing.
Stop spending evenings on documentation
WellNotes generates complete clinical notes in 2 minutes. Starting at $27/month.
Cancel anytime · Secure & private