Medical billing codes play an important role in the healthcare industry. They help healthcare providers accurately bill insurance companies and patients for their services. Cpt code 99214 is one such code that healthcare providers commonly use in their medical claims and bills. It denotes a level four evaluation and management (E&M) service healthcare providers provide. In this article, we will explore what 99214 CPT code is, how it works, and why it is significant in the healthcare industry.
CPT 99214 was developed by the American Medical Association (AMA) in the 1990s as part of the Current Procedural Terminology (CPT) coding system.
The concept of medical billing is very well developed in the United States of America and hence there are numerous codes that tend to govern the different types of systems. One such very important and commonly used set of codes is the CPT code. The term CPT refers to current procedural terminology. CPT code 99214 is used for established patient E/M services.
Table of Contents
- What Does The CPT Code 99214 stand for?
- CPT Code 99213 Reimbursement Rate in 2026:
- How Does Cpt Code 99214 Work?
- 99214 CPT Code vs. Other E&M Codes
- FAQs: Frequently Asked Questions
- Conclusion:
- Related Articles:
What Does The CPT Code 99214 stand for?
Cpt code 99214 is a medical billing code that describes a level four E&M service provided by healthcare providers. The E&M service is a standard set of procedures healthcare providers use to evaluate, diagnose, and treat patients. The level four E&M service is the second highest level of service provided by healthcare providers.
CPT Code 99213 Reimbursement Rate in 2026:
The same stands for the CPT 99214. This code is usually used for all those offices or outpatient services that require at least two of the three components which include a detailed history, a detailed examination, and finally the medical decision as well.
| Facility | Proposed 2026 Rate | 2025 National Rate |
|---|---|---|
| Non-Facility (Office) | $94.91 | $88.95 |
| Hospital/Outpatient | $56.81 | $63.72 |
How Does Cpt Code 99214 Work?
99214 CPT Code works by providing healthcare providers with a standard set of guidelines that they can use to bill insurance companies and patients for the level 4 E&M service they provide. The guidelines help healthcare providers document their services, including the history of the patient’s illness, the physical examination, and the medical decision-making process.
The documentation of these services is essential because it helps insurance companies determine the reimbursement level that should be provided to the healthcare provider. The more comprehensive the documentation, the higher the reimbursement level the healthcare provider will likely receive.
Procedure code 99214 reimbursement rate as per AMA in 2023 is as per below mentioned table,
99214 CPT Code vs. Other E&M Codes
Procedure code 99214 is one of several E&M codes used by healthcare providers. The other codes are:
- Cpt code 99211 – A level one E&M service provided by healthcare providers, which involves a brief evaluation and management of the patient’s condition.
- Cpt code 99212 – A level two E&M service provided by healthcare providers, which involves a limited evaluation and management of the patient’s condition.
- Cpt code 99213 – A level three E&M service provided by healthcare providers, which involves an intermediate evaluation and management of the patient’s condition.
- Cpt code 99215 – A level five E&M service provided by healthcare providers, which involves a comprehensive evaluation and management of the patient’s condition.
CPT 99214 complete information PDF
Note- Pdf Source – Alabama Public Health
FAQs: Frequently Asked Questions
Ans. The 99214 CPT code is valid only if you require one out of the three components which we have already mentioned. When all of the three components are required it falls under a different CPT code and it is unique as well. Hence one has to be very careful when it comes to billing.
Ans. One of the major advantages of the CPT code is that it is widely used all across the United States of America. It can be seen with conviction that the CPT code 99214 is widely used because the number of patients required for the two out of three components is quite high rather than the three out of three population.
Ans. Yes, there are limitations when it comes to billing complying under the CPT code 99214. In this case, the number has been set to 2 billings per year for both patients as well as physicians.
Ans. Procedure code 99214 describes a level four evaluation and management service, while CPT 99213 describes a level three evaluation and management service.
Conclusion:
Cpt code 99214 is a crucial medical billing code that helps healthcare providers to accurately bill insurance companies and patients for a level four evaluation and management service. By using 99214 CPT code, healthcare providers can ensure that they are billing for medically necessary services supported by proper documentation, which helps reduce the risk of fraud and abuse in the healthcare industry.
Related Articles:
CPT Code 99213 Description and Uses
The author and contributor of this blog "NSingh" is working in Medical Billing and Coding since 2010. He is MBA in marketing and Having vaste experience in different scopes of Medical Billing and Coding as AR-Follow-up, Payment Posting, Charge posting, Coding, etc.