99214 vs 99215 (E/M selection)
99214 is moderate-complexity MDM. 99215 is high complexity — typically a chronic illness with severe exacerbation, or 40–54 minutes on the date of service.
Last reviewed May 24, 2026
Side by side
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 includes prescription drug management.
- Time range (2026): 30–39 minutes.
CPT 99215
Established-patient office visit with high medical decision making, or 40–54 minutes of total time on the date of the encounter.
CPT 99215- High MDM: chronic illness with severe exacerbation or threat to life; extensive data; high risk.
- Time range (2026): 40–54 minutes.
When to use CPT 99214
- Patient with diabetes and hypertension reviewed together, both stable, medication renewed.
- Acute illness with systemic symptoms; prescription written.
When to use CPT 99215
- Patient presents with severe asthma exacerbation, decision made to start oral steroids and arrange same-day pulmonology referral.
- Chronic illness with progression to organ-threatening status, with drug therapy requiring intensive monitoring (e.g., immunosuppressants requiring labs).
- Total time on the date of the visit lands in the 40–54 minute band.
Common mistakes
- Billing 99215 for a long visit that was mostly counseling about non-medical issues without high MDM.
- Missing a 99215 when documentation actually supports severe exacerbation and intensive monitoring.
- Confusing total time on the date of service with time spent on the phone the next day.
Sources
- AMA CPT E/M Guidelineshttps://www.ama-assn.org/practice-management/cpt/cpt-evaluation-and-management
- CMS — Evaluation & Management Visitshttps://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/em-visits
Related
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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.