The Short Answer
Bill 99214 when the visit needed moderate medical decision making, or at least 30 minutes of the provider's total time that day. Bill 99213 for low decision making, or at least 20 minutes. You can pick the level by decision making or by time, whichever supports the higher level. You do not need both.
Both codes are for established patients seen in an office or other outpatient setting. A new patient visit uses 99202 to 99205 instead.
99213 vs 99214 at a Glance
| 99213 | 99214 | |
|---|---|---|
| Medical decision making | Low | Moderate |
| Total time on the day of the visit | 20 minutes or more | 30 minutes or more |
| Work RVUs (2026) | 1.30 | 1.92 |
| Total RVUs, office (2026) | 2.85 | 4.06 |
| Medicare 2026, office (national) | $95.19 | $135.61 |
| Medicare 2026, facility (national) | $57.45 | $84.50 |
Rates come from the CMS 2026 fee schedule at the $33.4009 conversion factor, before your local adjustment. Check your area in our Medicare fee lookup.
Choosing by Time
Total time means everything the provider did for that patient on the day of the visit. That includes reviewing tests, talking with the patient, ordering, writing the note and coordinating care. It does not include time spent by staff, or work done on a different day.
| Code | Total time needed (since 2024) |
|---|---|
| 99212 | 10 minutes or more |
| 99213 | 20 minutes or more |
| 99214 | 30 minutes or more |
| 99215 | 40 minutes or more |
If you bill by time, write the total minutes in the note and what they were spent on. A visit that runs well past the 99215 time can add a prolonged service code: 99417 for most payers, or G2212 for Medicare.
Choosing by Medical Decision Making
Medical decision making (MDM) has three parts. A visit reaches a level when two of the three parts meet it.
| Part | Low (99213) | Moderate (99214) |
|---|---|---|
| Problems addressed | One stable long-term illness, or one simple short-term illness or injury | One long-term illness that is getting worse, or two or more stable long-term illnesses, or a new problem with an unclear outcome |
| Data reviewed | Two items, such as two test results or a test and an outside note, or an independent historian | Three items (tests, outside notes or an independent historian), or reading another provider's test yourself, or discussing the case with an outside provider |
| Risk of the plan | Low, such as over-the-counter drugs | Moderate, such as managing a prescription drug |
Three Examples
99213: A patient comes in with a simple sinus infection and gets a prescription. The problem is low, the data is minimal and the prescription makes the risk moderate. Two parts reach low or higher, but only one reaches moderate, so the visit is 99213.
99214: A patient with diabetes and high blood pressure, both stable, has their blood pressure drug adjusted. Two stable long-term illnesses make the problems moderate, and changing a prescription makes the risk moderate. Two of three parts are moderate, so the visit is 99214.
99214 by time: The problem is simple, but the provider spends 34 minutes on it in total that day. That time goes to reviewing outside records, talking with the patient and writing the note. Time alone supports 99214.
What Picking the Wrong Level Costs
The 2026 Medicare difference between the two codes is $40.42 a visit in an office ($135.61 minus $95.19). A provider who codes ten 99214 visits a week as 99213 gives up about $19,400 a year at Medicare rates. Undercoding out of fear of audits is one of the most common revenue leaks we find.
Overcoding costs more in the end. Payers compare each provider's mix of levels with their peers. A provider who bills mostly 99214 and 99215 without notes that support it can expect records requests and paybacks. Use the E/M code level calculator to check a visit against the rules before you bill it.
Add-On Codes Worth Knowing
G2211 adds $17.37 nationally to a Medicare office visit when the provider is the patient's ongoing point of care for a serious or complex condition. In most cases it is not paid when modifier 25 is used for a same-day procedure.
Modifier 25 goes on the 99213 or 99214 when a separate, significant visit happens on the same day as a minor procedure. See our modifier 25 guide for when it applies.
Related
Full guides to CPT 99213 and CPT 99214, the RVU values for common CPT codes, and the Medicare fee lookup.
Frequently Asked Questions
Reviewed by Hassan Raza Awan, Founder — 4+ years of hands-on U.S. medical billing experience. General billing information — verify against current CMS guidance and your payer contracts.
Next level up: read 99214 vs 99215. Long visit? Work out the add-on with the prolonged services calculator, and check patient type with the new vs established patient checker. Rates drop about 3% in 2027, and G2211 becomes modifier B1. See our 2027 fee schedule guide. See what 99213 and 99214 pay in your area with our Medicare fee schedule lookup by ZIP code. See what your visit mix adds up to with our wRVU calculator.
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