CPT Code 99214 – Moderate Complexity E/m Billing Guide [+Reimbursements]

This post will give you insight into billing for procedure code 99214. This definitive guide will help you avoid under-coding and allow for more accurate billing. If you’re sick of dealing with the hassle of insurance billing, reach out to us for help!

CPT Code 99214: Evaluation and Management Definition

Evaluation and management of an established patient in an office or outpatient location for 25 minutes.

Procedure Code 99214 Description

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three components to be present in the medical record:

  • Components for CPT 99214A problem focused history
  • A problem focused examination
  • Decision making regarding treatment is moderate complexity

It’s important to note that the presenting problem(s) are moderate complexity. Physicians typically spend 25 minutes face-to-face with the patient and/or family.

(Source)

99214 Billing Tip!

Remember that you only need two of the three elements, so you can bill for taking history and medical decision making. Don’t worry if you haven’t done an exam, as long as the appointment is 25 minutes and you’ve completed the other two elements! This will help you bill more frequently for code 99214.

(Source)

Procedure Code 99214 Time LengthE/M CPT Code Time Length

Length of time for code 99214 is 25 minutes. See the table for time length for all E/M visits.

Additionally, don’t forget to check out our Psychiatry Billing Code Cheat Sheet!

99212 vs 99213 vs 99214 vs 99215:  Evaluation and Management

Generally, these billing codes are differentiated by amount of time spent with the patient and severity of the presenting problem. They are all part of HCPS, the Healthcare Common Procedure Coding System. 99214 should be used for patients whose appointments are 25 minutes and whose treatment is considered as being of moderate complexity. Other CPT code severity requirements are listed below:E/M CPT Codes

  • 99212: straightforward
  • 99213: low
  • 99214: moderate
  • 99215: high

(Source)

(Source)

Wondering if there’s an easier way to navigate billing codes? Consider hiring a team of billing experts at Therathink.

CPT Code 99214 Reimbursement Rate

Medicare reimburses for procedure code 99214 at $110.43.

Procedure Code 99214 Reimbursement Rates – Medicare

CPT CodeService TimeRate
9921210 minutes$46.13
9921315 minutes$68.10
9921425 minutes$110.43
9921540 minutes$148.33

99214 Reimbursement Rates – Medicaid

CPT CodeService TimeRate
9921210 minutes$31.36
9921315 minutes$43.23
9921425 minutes$66.80
9921540 minutes$99.95

99214 Commercial Insurance Reimbursement Rates According to Medicare

Here are the rates that Medicare believes are the commercial insurance rates for these services (this is not the Medicare rate for 99214):

CPT CodeService TimeRate
9921210 minutes$90
9921315 minutes$90
9921425 minutes$90
9921540 minutes$148

These rates are adjusted down and reflect what Medicare has deemed are average rates for most psychiatrists across the United States. These rates are adjusted by Medicare.

Some insurance companies only pay 15% over the Medicaid rate in their state, whereas others pay 45%, 60%, 80%, 85% on top of their state’s medicaid rate.

You can see these rates vary across insurance companies. It’s important to keep this in mind when working on your mental health insurance credentialing applications.

Reach out for help from us about suggestions!

Evaluation and Management Codes:  New vs Established Clients

Psychiatry codes 99212 through 99215 and 99202 through 99205 are differentiated by clients being new or established.

Make sure code 99214 is only used with established clients you have already seen.

Getting Help Billing

Is all of this gibberish? We established a mental health billing service at TheraThink to help you stay away from all this jargon so you can focus on what you do best. Reach out now for more information on our services.

Sources

https://www.aafp.org/fpm/2003/1000/p31.html#:~:text=CPT%20defines%20a%2099214%20or,of%20the%20level%20of%20service.

https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf

CPT Codes 99212 and 99213: Decide Which Code to Use for Behavioral Assessment Billing

Share with your colleagues:

No comments yet.

Leave a Reply