99213 vs 99214: what separates the two levels
Both codes report an office or other outpatient visit for an established patient. The difference is one level of medical decision making, or ten minutes of total time, and the note has to show whichever path is used.
| 99213 | 99214 | |
|---|---|---|
| Patient | Established | Established |
| MDM level | Low | Moderate |
| Problems addressed (any one) |
|
|
| Risk of management | Low risk of morbidity from additional diagnostic testing or treatment | Moderate risk of morbidity from additional diagnostic testing or treatment
|
| Minimum total time | 20 minutes (20–29) | 30 minutes (30–39) |
The short answer
99214 is supported when two of the three MDM elements reach the moderate level, or when total time on the date of the encounter is at least 30 minutes. 99213 is supported at the low level or at 20 minutes. Neither code depends on how much history or examination was documented; that has been the rule since January 1, 2021.
By medical decision making
The AMA's Table 2 draws the line with examples. On the problems element, a single stable chronic illness is low; one or more chronic illnesses with exacerbation, progression, or side effects of treatment, or two or more stable chronic illnesses, are moderate. On the risk element, low risk carries no listed examples, while prescription drug management is the AMA's first example of moderate risk. The data element follows its own category counts, listed in the guide. Two elements decide it: a visit with a worsening chronic illness that ends in a prescription change reaches moderate on problems and risk, so it supports 99214 without the data element reaching that level.
By time
On the time path the two codes are ten minutes apart: 20 minutes supports 99213, 30 minutes supports 99214. All of the practitioner's time on the date of the encounter counts, face-to-face or not, as long as the activity is not separately reported; the guide lists what counts.
Questions
Can 99214 be reported on time alone?
Yes. If the practitioner’s total time on the date of the encounter is at least 30 minutes, 99214 is supported by time regardless of the MDM level; below that, 99213 is supported at 20 minutes or more.
What moves a visit from 99213 to 99214 under MDM?
Two of the three elements reaching the moderate level instead of low. For example, a chronic illness with exacerbation, progression, or side effects of treatment is a moderate-level problem, and prescription drug management is a moderate-level risk in the AMA’s examples; a single stable chronic illness with low risk stays at 99213.
Sources
- CPT® Evaluation and Management (E/M) Office or Other Outpatient and Prolonged Services code and guideline changes, effective January 1, 2021 (opens in a new tab) — American Medical Association (with March 9, 2021 technical corrections)
- Evaluation and Management Services (MLN006764), May 2026 revision (opens in a new tab) — Centers for Medicare & Medicaid Services
Last reviewed September 29, 2026 · CPT® is a registered trademark of the American Medical Association · Full guide: How E/M coding works