CPT 99214: Established Patient Office Visit, Moderate Complexity
CPT 99214 reports an established patient office or outpatient visit with moderate medical decision making or 30-39 minutes of total time. It is the workhorse level-4 code for primary care. In 2026 Medicare pays about $135.61 non-facility (4.06 total RVUs times the $33.4009 conversion factor).
- Code type
- Established patient E/M (office/outpatient)
- 2026 non-facility
- $135.61 (4.06 RVUs)
- 2026 facility
- $84.50 (2.53 RVUs)
- Time (if used)
- 30-39 minutes total on the date
What is CPT 99214 used for?
CPT 99214 is an office or other outpatient visit for an established patient that requires a moderate level of medical decision making (MDM) or 30-39 minutes of total time on the date of the encounter. It is the most-billed level-4 code in family medicine, internal medicine, and most outpatient specialties, and for many practices it is the single largest line of professional revenue.
Since the 2021 E/M overhaul you choose the level two ways: by MDM or by total time. History and exam no longer drive the code, though they still must be medically appropriate. Pick whichever pathway your documentation actually supports.
How much does 99214 pay in 2026?
99214 carries 4.06 total non-facility RVUs and 2.53 facility RVUs. Multiply by the 2026 conversion factor of $33.4009:
| Setting | Total RVUs | 2026 Medicare allowed |
|---|---|---|
| Non-facility (office) | 4.06 | ~$135.61 |
| Facility (hospital outpatient) | 2.53 | ~$84.50 |
The office rate is higher because the practice, not a facility, absorbs staff and overhead (the practice-expense RVUs). Run your own locality-adjusted number through the Medicare fee calculator. Commercial payers commonly reimbursement 99214 at 110-160 percent of the Medicare rate.
How do you document to support a 99214?
The audit risk with 99214 is not fraud, it is thin notes. Under the MDM pathway you generally need two of three moderate elements: number and complexity of problems, amount of data reviewed, and risk. Common qualifiers:
- One chronic illness with exacerbation or progression, or two stable chronic conditions.
- An undiagnosed new problem with an uncertain prognosis.
- Prescription drug management (starting, stopping, or adjusting a medication).
How does 99214 fit the established-patient family?
99214 sits one step below the top of the established-patient ladder. Coding one level low across a panel (downcoding to 99213 out of caution) quietly gives away roughly $40 per visit.
- 99212 - straightforward MDM, 10-19 minutes.
- 99213 - low MDM, 20-29 minutes.
- 99214 - moderate MDM, 30-39 minutes.
- 99215 - high MDM, 40-54 minutes.
When the visit is with a physician who serves as the continuing focal point for the patient's care, you may also add complexity code G2211, which pays roughly $17 more. Example: a diabetic with worsening control seen for 34 minutes, insulin adjusted, supports 99214 plus G2211 for about $152.98 in 2026.
Frequently asked questions
When you code by time, 99214 requires 30-39 minutes of total time the physician or QHP spends on that patient on the date of service. That includes chart review, the face-to-face visit, ordering, and documentation done before midnight. If you code by medical decision making instead, time is irrelevant and moderate MDM controls.
In 2026 the national non-facility allowed amount is about $135.61 (4.06 total RVUs times the $33.4009 conversion factor). In a facility place of service it is about $84.50 (2.53 RVUs). Medicare pays 80 percent and the patient or secondary plan owes the 20 percent coinsurance after the deductible.
99213 is low complexity (20-29 minutes); 99214 is moderate complexity (30-39 minutes). Moderate MDM typically means a chronic illness with exacerbation, an undiagnosed new problem with uncertain prognosis, prescription drug management, or two stable chronic conditions. The documentation must show that heavier problem-and-risk load, not just a longer note.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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