Find policies, billing codes, payers, states, and providers
CPT 99214: Office Visit for Established Patients, Moderate Complexity
CPT code 99214 represents an evaluation and management office or outpatient visit for an established patient with moderate medical decision making or 30 minutes or more of total provider time. Nationally, 99214 is a widely used E/M code for ongoing chronic care and more complex outpatient problems; it is significant for practice workflow, documentation, and payment policy given its place between lower- and higher-intensity established patient visits. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare.
Readers will find a concise overview of clinical context and common presenting conditions appropriate for this level of care, comparisons to adjacent established-patient E/M codes (99213 and 99215), and practical information on sites of service and typical service duration. The publication summarizes typical ICD-10 diagnoses often billed with this code, highlights associated clinical taxonomies such as Family Medicine and Internal Medicine, and outlines related preventive and care-planning codes that clinicians may consider in the same episode of care. It also covers common modifiers used with E/M visits and notes when time-based reporting applies. The focus is national policy and billing context rather than state-specific rules.
Customize your policy alerts
Sign up for cpt 99214 policy alerts
Get alerted when payer policies referencing 99214 are released or updated.
Monitor payer policy activity
Billing Code Overview
CPT code 99214 describes an office visit or other outpatient visit for an established patient that involves a moderate level of medical decision making and/or 30 minutes or more of total provider time on a single date. This service is commonly delivered as an evaluation and management (E/M) encounter.
Service type: Evaluation and management (established patient office or outpatient visit)
Typical site of service: Office or outpatient clinic
National Reimbursement Benchmarks
Medicare and BUCA (an average commercial benchmark) sit near one another on mean reimbursement: Medicare's mean is $139.9 versus BUCA's mean of $154.8, a modest commercial premium of about $14.9. That proximity suggests that for CPT 99214 national average payments cluster in the low-to-mid $130s–$150s range rather than diverging to extremes.
Dispersion measured by the interquartile spread (P75−P25) varies notably across payers. Blue Cross Blue Shield has a relatively wide IQR of $77.2, while Aetna's IQR is $77.6 and UnitedHealth Group's IQR is $86.6; Cigna's IQR is $88.0. BUCA's IQR is $81.3 and Medicare's IQR is $12.0, making Medicare the tightest distribution and Cigna the widest among listed payers.