The 99214 CPT code is used to report office or other outpatient visits established patient for the evaluation and management of an established patient that requires at least 2 of these 3 key components: a detailed history, a detailed examination, and medical decision making of moderate complexity.
Key Features of 99214 CPT Code:
Modifiers for 99214 CPT Code:
Several modifiers can be used with the 99214 CPT code to provide additional information about the service provided. Some common modifiers include:
Documentation Requirements for 99214 CPT Code:
To support billing for the 99214 CPT code, the medical record should include documentation that meets the following criteria:
History:
Examination:
Medical Decision Making:
Coding and Billing Considerations:
The 99214 CPT code is typically billed at a rate ranging from $75 to $150 depending on factors such as geographic location, practice type, and the complexity of the services provided.
Effective Strategies for Optimizing Reimbursement:
How to Bill 99214 CPT Code Step-by-Step:
Pros and Cons of Using 99214 CPT Code:
Pros:
Cons:
FAQs on 99214 CPT Code:
The 99214 CPT code requires at least 2 of the 3 key components (detailed history, detailed examination, medical decision making of moderate complexity), while the 99213 CPT code requires only 1 of the 3 key components.
No, the 99214 CPT code requires a visit duration of at least 15 minutes.
The medical record should include documentation of a detailed history, detailed examination, and medical decision making of moderate complexity.
The appropriate modifier will depend on the specific circumstances of the patient encounter. Refer to the CPT code guidelines for specific guidance.
Yes, provided that the telehealth visit meets all other requirements for the 99214 CPT code.
The average reimbursement rate for the 99214 CPT code varies depending on geographic location and other factors. Refer to your local Medicare Administrative Contractor (MAC) for specific reimbursement information.
Tables:
Table 1: Comparison of 99213 and 99214 CPT Codes
Feature | 99213 CPT Code | 99214 CPT Code |
---|---|---|
Duration | 10-14 minutes | 15-29 minutes |
Key Components | 1 of 3 (detailed history, detailed examination, medical decision making of moderate complexity) | 2 of 3 (detailed history, detailed examination, medical decision making of moderate complexity) |
Reimbursement Rate | Lower | Higher |
Table 2: Medicare Reimbursement Rates for 99214 CPT Code by Region (2022)
Region | Reimbursement Rate |
---|---|
Northeast | $105-$120 |
Midwest | $95-$110 |
South | $85-$100 |
West | $110-$125 |
Table 3: Common Modifiers for 99214 CPT Code
Modifier | Description |
---|---|
-25 | Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service |
-57 | Decision for surgery |
-59 | Distinct procedural service |
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