CPT 99214: Office Visit for Established Patients, Moderate Complexity
Medicare pays $140 and commercial payers pay $155 on average nationally for this procedure.
CPT code 99214 describes an established patient office or other outpatient visit involving evaluation and management at a moderate level of medical decision making or with 30 minutes or more total time spent on the single-date encounter; the service is an E/M office visit and the typical site of service is an outpatient clinic or physician office setting.
For related coverage guidance, see recent payer policy updates: Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults, Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in Adults, Site of Service Ambulatory Service Center (ASC) Select.
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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.