CPT code 99214: Office visit, established patient, moderate complexity2026 Medicare rate & RVUs

Medicare pays $135.61 for 99214 nationally in the office and $84.50 in a hospital or facility. Local office rates run $123.92–$170.02.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99214 covers

This visit covers an established patient seen in an office or other outpatient setting for care involving moderate medical decision making. A patient is established when they received professional services from the same practitioner, or another of the same specialty and subspecialty in the same group, within the past three years. Moderate-level problems may include two stable chronic illnesses, such as hypertension and type 2 diabetes, a worsening chronic condition, or an undiagnosed problem with an uncertain prognosis. Another decision-making element must also reach the moderate level. Physicians, nurse practitioners, and physician assistants report these visits in primary care and specialty clinics. CMS ranks this code first among priced codes by Medicare service volume.

Select the level by medical decision making or time. Moderate decision making requires two of three elements: problems addressed, data reviewed or ordered, and risk of management. For time, document at least 30 minutes of the billing practitioner's total time on the visit date, including personally performed non-face-to-face work such as reviewing results and documenting, but excluding clinical staff time and separately billed services. Work RVUs make up 47% of the office total; practice expense is lower in a facility setting.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 99214 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99214 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 99214 rate is calculated

Each of 99214’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 99214

99214 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate. Billing it with a same-day procedure? See modifier 25.

99214 compared with similar codes

How to choose

99213Office visitEstablished patient, low complexity

99213 fits low decision making or at least 20 minutes. 99214 requires two moderate decision-making elements, potentially including problems such as two stable chronic illnesses, or at least 30 minutes.

99215Office visitEstablished patient, high complexity

99215 requires two high decision-making elements or at least 40 minutes. A severe exacerbation or a hospitalization decision can contribute to high decision making but does not establish the level alone.

99204Office visitNew patient, moderate complexity

99204 is for a new patient and requires moderate decision making or at least 45 minutes. New-patient status depends on professional services received from the practitioner or another of the same specialty and subspecialty in the group within three years.

99232Subsequent hospital visitModerate MDM or 35 minutes

99232 applies to subsequent hospital inpatient or observation care. 99214 is for an established patient's office or outpatient clinic visit rather than inpatient or observation care.

Codes related to 99214

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates