Comparison · Coding

99213 vs 99214 (E/M selection)

99213 is a low-complexity established-patient office visit. 99214 is moderate complexity. Selection is by MDM or by total time on the date of service.

Last reviewed May 24, 2026

Side by side

Option A

CPT 99213

Established-patient office or other outpatient visit with low-level medical decision making, or 20–29 minutes of total time on the date of the encounter.

CPT 99213
  • Low MDM: low number/complexity of problems, limited data, low risk.
  • Time range (2026): 20–29 minutes.
Option B

CPT 99214

Established-patient office visit with moderate medical decision making, or 30–39 minutes of total time on the date of the encounter.

CPT 99214
  • Moderate MDM: moderate problems, moderate data, moderate risk (e.g., prescription drug management).
  • Time range (2026): 30–39 minutes.
Number and complexity of problems
99213Low — 2 self-limited, or 1 stable chronic
99214Moderate — 1 chronic with exacerbation, 2+ stable chronic, or 1 acute illness with systemic symptoms
Amount and complexity of data
99213Limited — review of prior notes, ordered/reviewed unique test
99214Moderate — review across 2 categories OR independent interpretation OR discussion with external provider
Risk
99213Low — OTC drugs, minor surgery without risk factors
99214Moderate — prescription drug management, decision for minor surgery with risk factors, social determinants of health affecting treatment
Time-based selection (2026)
9921320–29 minutes total time on date of encounter
9921430–39 minutes total time on date of encounter

When to use CPT 99213

  • Stable chronic disease check (e.g., well-controlled hypertension on the same regimen) with limited data review.
  • Acute uncomplicated problem with no prescription drug management and no test ordering beyond a routine lab.
  • Total time on the date of the visit lands in the 20–29 minute band.

When to use CPT 99214

  • Two or more stable chronic conditions reviewed together.
  • A chronic condition with an exacerbation requiring medication adjustment.
  • Prescription drug management of any kind (Rx management is moderate risk).
  • Total time on the date of the visit lands in the 30–39 minute band.

Common mistakes

  • Counting time spent on the day before or after the encounter — the 2021+ rules restrict time to the date of service.
  • Defaulting to 99213 to avoid audit risk when the documentation supports 99214 — leaves revenue on the table.
  • Defaulting to 99214 without documentation supporting moderate MDM or 30+ minutes — invites a downcoded denial.

Sources

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Authored by D3rx

D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.

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This comparison is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at CMS, HHS, OCR, eCFR, NIST, and the relevant payer or state regulator. Last reviewed May 24, 2026.