2025 CPT code 99214
(Revised) Effective Date: N/A Revision Date: N/A Evaluation and Management - Office or Other Outpatient Services Evaluation and Management Feed
Office or outpatient visit for an established patient; requires medically appropriate history and/or examination and moderate medical decision-making; 30 minutes or more of total time spent on the encounter date.
Modifiers may be applied to this code as clinically appropriate (e.g., Modifier 25 for a significant, separately identifiable E/M service on the same day of a procedure).
The medical necessity of the visit is established by the complexity of the patient's condition, the need for a comprehensive evaluation, the medical decision-making involved, and the time required to provide appropriate care.Documentation should justify the level of service provided.
The provider performs a comprehensive evaluation and management service for an established patient, including history taking, physical examination (if appropriate), and medical decision-making. This may involve coordinating care with other healthcare professionals and extensive patient education and counseling.
In simple words: This code is for a doctor's visit for a patient they've seen before. The visit takes at least 30 minutes, and the doctor makes decisions about the patient's care that are moderately complex.This includes time spent talking to the patient, doing tests, and talking to other doctors.
This CPT code represents an office or other outpatient visit for the evaluation and management of an established patient.The visit necessitates a medically appropriate history and/or examination, along with a moderate level of medical decision-making.When using time to select the code, a minimum of 30 minutes of total time must be spent on the encounter date.This total time includes both face-to-face and non-face-to-face activities such as reviewing tests, preparing for the visit, performing the exam, counseling, educating the patient, ordering tests, communicating with other providers, documenting the encounter, interpreting and communicating results, and coordinating care.The level of medical decision-making is determined by the number and complexity of problems addressed; the amount and complexity of data reviewed and analyzed; and the risk of complications, morbidity, and mortality related to patient management.
Example 1: A 65-year-old established patient presents with worsening shortness of breath and chest pain.The physician performs a detailed history, comprehensive physical exam, orders an EKG and chest X-ray, consults with a cardiologist, and spends over 45 minutes counseling the patient and family about treatment options, including lifestyle changes and medication., A 40-year-old established patient with diabetes comes in for routine follow-up. The physician reviews lab results, discusses medication adjustments, spends significant time addressing the patient's concerns about diet and exercise, and coordinates care with a diabetes educator. The total time spent on the encounter is 35 minutes., A 22-year-old established patient presents with a complex skin rash.The physician performs a thorough history, detailed dermatological examination, considers various differential diagnoses, orders allergy testing, and spends 30 minutes discussing treatment options and potential side effects.
Detailed documentation should include the chief complaint, history of present illness, review of systems, past, family, and social history (as appropriate), detailed physical examination findings, assessment and plan, and any communication with other healthcare providers.Total time spent on the encounter should be clearly documented.
** Accurate coding requires a thorough review of the patient's medical record to ensure that all documentation supports the level of service billed.Any discrepancies should be thoroughly investigated and resolved.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Most medical specialties may utilize this code, depending on the nature of the patient encounter.
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center