99214·CPT (AMA) · Evaluation & Management

Office Visit, Established Patient, Moderate Complexity

Most commonly billed E/M code for established-patient psychiatric medication management. Selected by either moderate-complexity medical decision-making or 30–39 minutes of total time on the date of encounter.

Descripteur de code (verbatim AMA)

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30 minutes of total time is spent on the date of the encounter.

Source: AMA Current Procedural Terminology, code 99214.

E/M code family, established patient office visits

CodeMDM levelTimeReimbursement
99211Minimal,$25–40
99212Straightforward10–19 min$50–75
99213Low20–29 min$80–120
99214**Moderate****30–39 min**$120–170
99215High40+ min$170–230

E/M code selection (since the 2021 overhaul) is based on either MDM or total time on the date of encounter, pick whichever more accurately reflects the visit. History and exam elements no longer drive selection.

Selecting 99214, two paths

Path 1

Medical Decision-Making (MDM)

Moderate-complexity MDM requires meeting/exceeding two of three:

  • Problems addressed: 1+ chronic illness with exacerbation/progression, 2+ stable chronic illnesses, undiagnosed new problem with uncertain prognosis, or acute illness with systemic symptoms.
  • Data reviewed: Two of three categories (review of external notes/tests, review of unique tests, history from independent source).
  • Risk: Moderate risk, prescription drug management, decision regarding minor surgery, social determinants of health affecting treatment.

Path 2

Total time on date of encounter

30–39 minutes total time on the date of encounter, including:

  • Pre-encounter chart review
  • Face-to-face time with patient and/or family
  • Counseling and education
  • Documentation in EHR
  • Care coordination, prescription writing
  • Communication with other providers

Time-based selection has become the dominant approach in psychiatric practice because medication management visits often involve substantial documentation, chart review, and care coordination beyond the face-to-face encounter.

Common ICD-11 pairings

99214 establishes the service performed; the paired ICD-11 code(s) establish medical necessity. Common psychiatric pairings:

  • F33.1, F33.2, recurrent depression, ongoing antidepressant management
  • F31.1, F31.81, bipolar disorder, mood stabilizer management
  • F41.1, generalized anxiety, SSRI/SNRI management
  • F43.10, PTSD, prazosin / SSRI management
  • F90.0, ADHD, stimulant or non-stimulant management
  • F42.2, OCD, high-dose SSRI management

See the full ICD-11 reference for diagnosis-specific scale recommendations to support medical-necessity documentation.

Pairing with psychotherapy add-ons

If the prescriber delivers both medication management AND psychotherapy in the same visit, bill 99214 plus a psychotherapy add-on code:

  • 90833, Psychotherapy add-on, 16–37 minutes (~$45–70)
  • 90836, Psychotherapy add-on, 38–52 minutes (~$70–110)
  • 90838, Psychotherapy add-on, 53+ minutes (~$100–150)

The add-on time is separate from the E/M time. Document the psychotherapy minutes distinctly (start/end of therapeutic intervention) within the visit note.

Sources

  • American Medical Association. Current Procedural Terminology (CPT) 2026, code 99214.
  • American Medical Association. 2021 E/M Coding Guidelines: Office and Other Outpatient Services.
  • Centers for Medicare & Medicaid Services. Physician Fee Schedule.

Foire aux questions

What is CPT 99214?

CPT 99214 is the AMA evaluation and management code for an established-patient office or outpatient visit requiring a moderate level of medical decision-making (MDM), or 30 to 39 minutes of total time on the date of the encounter. It is the most commonly billed E/M code for established-patient psychiatric medication management.

Who bills 99214?

Prescribers, psychiatrists, psychiatric nurse practitioners, physician assistants, and primary care physicians. Therapists, psychologists, and counselors typically bill psychotherapy codes (90832/90834/90837) instead because they don't perform the medical management that the E/M codes capture.

How do I choose between 99213 and 99214?

Both are established-patient E/M codes. 99213 is low-complexity (15–24 min or low MDM); 99214 is moderate-complexity (30–39 min or moderate MDM). Selection is based on either total time on the date of encounter OR the level of medical decision-making, pick the one that more accurately reflects the visit. As of the 2021 E/M overhaul, history and exam elements no longer drive code selection, MDM and time do.

What does 99214 reimburse?

Reimbursement varies by payer. Approximate national medians: $120–170 per visit for commercial payers. Medicare's 2026 Physician Fee Schedule rate is the public benchmark; commercial payer rates vary by contract. 99214 reimburses ~50% more than 99213 ($80–120) reflecting the moderate-MDM clinical complexity.

Can 99214 be billed alongside 96127 or psychotherapy add-ons?

Yes. 99214 is the primary service code; 96127 (brief assessment) and psychotherapy add-on codes (90833, 90836, 90838) can be billed alongside on the same encounter. A typical psychiatric medication management visit billing PHQ-9 + GAD-7 administration is 99214 + 96127×2. If the prescriber also delivers psychotherapy in the same visit, add 90833 (16–37 min add-on), 90836 (38–52 min), or 90838 (53+ min).

What documentation is required for 99214?

Either MDM-based or time-based documentation. MDM requires moderate complexity in two of three: number/complexity of problems addressed, amount/complexity of data reviewed, risk of complications. Time-based requires documenting total time on the date of encounter (30–39 minutes for 99214) including non-face-to-face activities like chart review and care coordination. As of 2021, comprehensive history and exam documentation no longer drive code selection.

How much does CPT 99214 pay?

CPT 99214 pays approximately $128 per visit under the 2026 Medicare Physician Fee Schedule national average for the non-facility setting, with locality adjustments. Commercial payer rates typically range from $120 to $170 per visit and vary by contract. CPT 99214 reimburses roughly 50% more than 99213 ($80 to $120) reflecting the moderate medical-decision-making complexity. Verify your specific payer fee schedule.

What is the difference between CPT 99214 and 99215?

Both are established-patient E/M codes. CPT 99214 is moderate complexity (30 to 39 minutes total time on the date of encounter, or moderate medical decision-making). CPT 99215 is high complexity (40 or more minutes, or high medical decision-making, such as a drug requiring intensive monitoring, decision regarding hospitalization, or severe acute illness). 99215 reimburses approximately $180 under 2026 Medicare versus $128 for 99214; use 99215 only when the clinical complexity genuinely meets the higher threshold.

Is CPT 99214 billable for telehealth?

Yes, CPT 99214 is billable for telehealth visits. Use place of service code 02 (telehealth, non-home) or 10 (telehealth, patient home), with modifier 95 for synchronous audio-video evaluation and management when required by the payer. Medicare extended telehealth coverage for E/M codes after the public health emergency. Audio-only 99214 has narrower payer rules and stricter documentation requirements; verify before billing telephone-only medication management visits.

How often can CPT 99214 be billed?

CPT 99214 can be billed once per visit per patient per provider, with no fixed annual frequency cap under Medicare. Medicare's Medically Unlikely Edit (MUE) limit is 1 unit per date of service. Most payers cover medication management visits as medically necessary, typically every 1 to 3 months for stable psychiatric patients. Document the medical decision-making complexity or total time on the date of encounter to support each 99214 claim.

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