CPT 99214 Fee Schedule
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.
| 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 |
National average reimbursement for CPT 99214 by major payers:
$130.37
$124.63
$119.38
$174.28
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99214 | ||||||
United | 99214 | $142.83 | 1457963548 - ANN ARMSTRONG | 561093722 - ORTHOCAROLINA, P.A. | NC | Physical Therapist (225100000X) |
United | 99214 | $137.86 | 1578512125 - UNIVERSITY OF MIAMI, UMIAMI MEDICINE - DERMATOLOGY | 592579938 - UNIVERSITY OF MIAMI | FL | Dermatology Physician (207N00000X) |
United | 99214 | $95.68 | 1972858629 - BEATRICE ROTIBI | 232285217 - (PA) CRITACUITY MEDICAL GROUP | PA | Internal Medicine Physician (207R00000X) |
United | 99214 | $68.31 | 1679843205 - TONILYN HATCH | 363142979 - (IL) ALLERGY ASTHMA MEDICAL ASSOCIATES LTD | AZ | Physician Assistant (363A00000X) |
United | 99214 | $87.81 | 1073526570 - MARK YAROS | 251441920 - UPMC | PA | Family Medicine Physician (207Q00000X) |
United | 99214 | $160.22 | 1710988498 - THOMAS WIGBOLDY | 203639329 | VA | Emergency Medicine Physician (207P00000X) |
United | 99214 | $128.08 | 1457322562 - JAY BERLAND | 135562308 - NEW YORK UNIVERSITY | NY | Pulmonary Disease Physician (207RP1001X) |
United | 99214 | $54.79 | 1508933094 - IMTIAZ CHAUDHARY | 1508933094 - IMTIAZ CHAUDHARY | NJ | Orthopaedic Surgery Physician (207X00000X) |
United | 99214 | $107.83 | 1962957639 - MODERA CLINIC PLLC | 812122050 - (TX) MODERA CLINIC, PLLC | TX | Family Medicine Physician (207Q00000X) |
United | 99214 | $138.03 | 1609099431 - KEITH DOMINICK | 20495638 | MA | Pediatrics Physician (208000000X) |
United | 99214 | $85.90 | 1538283502 - PANAGIOTIS MITROPOULOS | 593549147 | FL | Dermatology Physician (207N00000X) |
United | 99214 | $193.16 | 1649449604 - VANDANA DUGGAL | 680360801 - JOHN MUIR PHYSICIAN NETWORK | CA | Family Medicine Physician (207Q00000X) |
United | 99214 | $89.41 | 1740620178 - HIGHTOWER DERMATOLOGY SERVICES, LLC | 264651127 - (FL) HIGHTOWER DERMATOLOGY SERVICES LLC | FL | Dermatology Physician (207N00000X) |
United | 99214 | $85.90 | 1841285723 - MELINDA GREENFIELD | 593549147 | FL | Dermatology Physician (207N00000X) |
United | 99214 | $68.70 | 1154565661 - BISHR AL DABAGH | 844002325 - (FL) BOLD CITY DERMATOLOGY LLC | FL | MOHS-Micrographic Surgery Physician (207ND0101X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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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 |
|---|---|---|
| 99211-CPT | Low | Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient, That May Not Require The Presence Of A Physician Or Other Qualified Health Care Professional. Usually, The Presenting Problem(S) Are Minimal. |
| 99212-CPT | Low | 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. (Desc Rvsd 1/1/2024) |
| 99213-CPT | Low | 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. (Desc Rvsd 1/1/2024) |
| 99214-CPT | Moderate | 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 Decisionmaking. When Using Total Time On The Date Of The Encounter For Code Selection 30 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024) |
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.
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