Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 99214 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Office O P Est Mod 30 Min, 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 Total Time On The Date Of The Encounter For Code Selection 30 Minutes Must Be Met Or Exceeded
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Office or Other Outpatient Services |
| Common Place of Service | 11 - Office 20 - Urgent Care Facility None |
| Common Modifiers | None 25 - Significant, separately identifiable E/M service same day 95 - Telemedicine - audio and video |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 99214 |
| Medicaid Fee Schedule | View Medicaid rates for 99214 |
National average reimbursement for CPT 99214 by major payers:
$130.37
$124.63
$119.38
$144.66
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 99214.
CPT 99214
5 of 25 sample ratesHigher to lower in this preview
Lisa Pavlovic
$332.83Published rateKathryn Wisser
Rocky Mountain Gastroenterology Associates, PLLC
$182.21Published rateUniversity Of Miami, Umiami Medicine - Dermatology
University Of Miami
$137.86Published rateMark Yaros
UPMC
$87.81Published rateImtiaz Chaudhary
$54.79Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalPayer payment policies430 policies from 25 payersChecked Oct 2026
Billing CPT 99214 with a preventive visit? UnitedHealthcare, Cigna and Florida Blue pay it at 50%.
UnitedHealthcare50% paid
When a problem-oriented E/M service is billed with a preventive medicine service on the same date by the same specialty provider, UnitedHealthcare pays the preventive visit plus 50% of the E/M code if modifier 25 is appended and the E/M is significant and separately identifiable.
Cigna50% paid
When preventive and problem-based E/M services are both performed on the same day and the policy criteria are met, the preventive service is paid at 100% and the problem-based E/M service is paid at 50%.
Florida Blue50% paid
When a significant separately identifiable problem-oriented E/M service is billed with a preventive medicine E/M service on the same day, the problem-oriented E/M is paid at 50% of its amount.
36 payment rules from 13 payers apply to CPT 99214
- Modifier requirements17 rules · 8 payers
- Reduced payment13 rules · 9 payers
- Bundled with other services3 rules · 2 payers
- Unit and frequency limits3 rules · 2 payers
Payers, conditions, and amounts are in the demo.
Which payer do you bill most?
Summaries by PayerPrice from payers' published policies, re-checked monthly. Not coding or legal advice.
CPT 99214 vs. Other Office or Other Outpatient Services Codes
The CPT 99214 code is part of the Evaluation and Management services used for Office or Other Outpatient Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99214 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99212-CPT | Low | Office O P Est Sf 10 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 10 Minutes Must Be Met Or Exceeded |
| 99213-CPT | Low | Office O P Est Low 20 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And Or Examination And Low Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 20 Minutes Must Be Met Or Exceeded |
| 99214-CPT | Moderate | Office O P Est Mod 30 Min, 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 Total Time On The Date Of The Encounter For Code Selection 30 Minutes Must Be Met Or Exceeded |
| 99215-CPT | High | Office O P Est Hi 40 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And Or Examination And High Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 40 Minutes Must Be Met Or Exceeded |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99214. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99214 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 99214) and we'll show you how you compare in 15 minutes or less.