CPT 99214 defined and usage examples
Summary:
CPT Code 99214 is one of the most commonly under used HCPCS in American Healthcare. Many clinics bill for an initial consult of 99204 when they should be billing for 99214 (existing patient consult). Learn the specifics of cpt code 99214 in this short article and avoid denials and payer recoveries.
AMA Description of CPT 99214
There's always a CMS/AMA definition and a layperson's term, see them here:
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
99203 CPT Description in Layperson's Terms
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more.
Current CMS Status of CPT 99214
These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy.
General Information about CPT Code 99214
99214 cpt code has a diagnostic family of 99, with no age range as it is follow-up visit with an existing patient. It's DX/Therapeutic category is "C." It's MUE Count is 2 and HOS MUE Count is 2.
Financial Details with CPT Code 99214
In iVECoder our AI scrubber for clinics and hospitals, you can set your GPCI settings and find all the financials details you need to know for cpt code 99214. The example we provided here show that for Los Angeles the Non-Facility fee at 100% to CMS is $140.96. The Facility Fee at 100% to CMS is $102.80. Now we all know that make a profit of almost any medicare claim you need to be paid at 120% or higher. So going into iVECoder you can then adjust the financial details at the bottom to edit "100%" to "120%."
In this side by side comparison you can see that you can use iVECoder to help negotiate the proper payments from your local payers for codes like 99214.
Avoid CPT 99214 Audits and Increase Your Compliance
Outpatient CCI Bundled Codes
There have been 182 related outpatient CCI bundled codes that correlate to cpt code 99214, but many of them are terminated and/or have been replaced by new codes. It's essential to stay on top of your bundled codes and never "unbundle" a code to gain a higher payout. This will result in audit and can hurt you provider scores.
APC Bundled codes for 99214
Accepted Modifiers of cpt code 99214
There are 62 modifiers right now that can be utilized for cpt code 99214. The fastest way to find if your claim requires one of these modifiers or if you've chosen the right modifier is to use iVECoder in a mock adjudication claim.
Summary of CPT 99202 and Initial Consult Coding
While information blogs like this are helpful, we caution against the usage of AI chatbots like ChatGPT to get your coding guidelines or answers. iVECoder is an AI medical coding scrubber for clinics and hospitals with an AMA license, and can help you gain more approvals with less liability for future audits. If you'd like to try iVECoder out, we offer month to month terms. See links below. Thank you for reading.
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Will Schmidt joined PCG Software as their Chief Strategy Officer in November 2022. Prior to PCG, Schmidt lead TNH as their Sr. Vice President to become the 7th largest pharmacy in the nation. He then went on to consult with and serve as Interim CEO or Consultant to over 20 different companies specializing in profit strategies, operational efficiencies, vendor relations and partnerships, and exit strategies, include an international Revenue Cycle Management Company.
