Reimbursement
$127.92
Threshold
30m
2026 Status
Active
What is CPT Code 99214?
CPT 99214 is defined as: 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 time for code selection, 30-39 minutes of total time is spent on the date of the encounter.
This code is primarily used for E/M services. It falls under the category of Evaluation & Management and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
1.92
Physician Effort
PE (Non-Fac)
1.78
Practice Expense
Malpractice
0.13
Risk Factor
Total RVU
3.83
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency shield
Protected from the -2.5% productivity adjustment (E/M service).
g2211 standard
99214 + G2211 is the most frequent billing combination for longitudinal specialist care in 2026.
Administrative Framework
Place of Service
Key Modifiers
Operational Requirements
selection criteria
Moderate MDM OR 30-39 minutes total time.
patient status
Established patient.
frequency
Once per encounter.
Compliance Checklist
Audit Defense
mdm moderate
Ensure documentation reflects at least 1 chronic illness with exacerbation OR 2+ stable chronic illnesses OR 1 new problem with uncertain prognosis.
2026 Update
2026 valuation continues to favor 99214 as a core revenue driver for both Primary and Specialty care.
Common Clinical Scenarios
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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