CPT 99214

Current Procedural Terminology (CPT) code systems improve medical treatments and services. Medical service providers and billing professionals need to have a thorough understanding of CPT codes due to the evolution of medical care field. The CPT 99214 Code is among one of the particular codes by CPT that are necessary to guarantee accurate invoicing with an excellent patient care.

We will thoroughly examine the specifics of the CPT 99214 Code, its appropriate use, and its significance within the medical services framework in this comprehensive guide.

CPT 99214 Description

CPT code 99214 covered the services that requires considerable medical direction. It provides as organized outpatient or equivalent brief interaction that takes 30 to 39 minutes. In order to use the 99214 CPT code correctly, the visit needs to fulfill certain requirements:

  • The person receiving treatment needs to arrange their sessions according to whether or not they have seen the provider or another provider at a comparable event in the previous three years.
  • A moderate medical decision-making intricacy is involved in this visit.
  • The appointment should last between thirty to forty-nine minutes in total.

The 99214 CPT code must be justified with appropriate documentation. Important components for the documentation consist of:

  • a thorough medical history of the current condition.
  • an extensive evaluation of the systems.
  • a thorough physical assessment.
  • recording of the process of making medical decisions.

99214 billing includes precisely recording the services rendered and ensures that this code is used in all documentation.

CPT 99214 Reimbursement

99214 reimbursement rates are always fluctuate based on the payer identities and the geological region. Although, due to its increased complexity and time requirements in comparison to lower-level codes like 99213, it typically gives higher reimbursement.

CPT 99214 Time

Generally, the provider visits with CPT code 99214 needs the patients to stay for a total of 30-39 minutes. It also includes a minimum of 25 minutes of direct contact with the person being treated or family. This code entails an average level of healthcare decision-making process. CPT 99214 code is utilized for stable patients.

CPT 99214 Modifier 25

In addition to coding for the cardiovascular stress test (93015), the doctor codes for an E/M visit (99214) with the help of modifier 25. Modifier 25 is applied to the Evaluation and Management (E/M) visit to show that there was an independently distinct E/M on the same day as a surgery.

CPT 99214 Modifier 95

Modifier 95 has been described as “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.” As per the American Medical Association.

CPT 99214 Cost

  • Description: Established Patient, Level IV
  • Medicaid cost: $84
  • Medicare cost: $109
  • Average cost: $245
  • Self-Pay Charge: $312

Terminologies Related to CPT

Office Visit Level I–V: A standard visit with a doctor who provides primary care is an office visit. The diagnosis, the intensity of treatment, and other factors determine the degree of visit.

Medicaid Fee-for-Service: The Minnesota Department of Human Services’ reimbursement percentage to clinicians for Medical Assistance enrollees in the fee-for-service program.

Medicare Allowed Amount: The Center for Medicare and Medicaid Services’ payment rate to providers for Medicare enrollees in conventional Medicare plans.

Insurance Payment: The average sum received for services provided to clients who are professionally insured (employer-sponsored, acquired straight from an insurer or MNSure) is known as the insurance payment.

CPT 99214 vs. 99213

In addition to the processing time, the two primary differences between CPT codes 99214 and 99213 are intricacy and duration. Compared to 99213, that is used for minimal complexity, 99214 is employed for intermediate complexity. It means that CPT 99214 requires a higher degree of healthcare decision-making in addition to a more complete history and assessment.

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