CPT 99214
Office visit, established patient, level 4
An established patient visit at moderate complexity: several chronic conditions reviewed, a new problem that needed a work-up, or prescription medicines managed. Or 30 to 39 minutes of the doctor's total time on the day.
Billed to Medicare
$276
What providers submitted, on average, for this code in an office.
Medicare accepted
$120
What Medicare treated as payable. Not a commercial rate or a cash price.
The gap
2.3x
How many times the accepted amount the billed figure was.
National averages from the Centers for Medicare & Medicaid Services, 2024 data, retrieved 2026-09-14. Medicare fee-for-service, physician and practitioner claims only. The hospital's own charge for the same code is separate and is usually higher. Based on 95,439,230.1 services.
Among the 4 doctor visits codes on this site with CMS figures, this gap ranks 3 of 4 (median 2.3x). The widest is Initial hospital care, high complexity at 3.4x.
Where this line goes wrong
The fastest-growing office code
Level 4 has taken share from level 3 steadily since the 2021 rule change. A short visit for one simple problem billed at level 4 is the pattern to ask about.
Prescription management counts
Renewing or adjusting a prescription drug is enough for moderate risk, which is one of the three elements. That is legitimate and explains many level 4 visits that feel short.
Check it, then ask
- 1
Compare the level to the visit: number of problems, tests ordered, prescriptions decided, and time.
- 2
Ask for the visit note if you want to check the documentation.
- 3
Check for a separate facility charge if the clinic is hospital-owned.
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Codes that travel with this one
People also ask
Can a 15-minute visit be a level 4?
Yes, if the medical decision making was moderate. Time is one route to the level, decision making is the other, and the doctor needs only one.
Sources
This page explains a billing code in general terms. It is not a coding, legal or medical opinion about your bill, and the code descriptions are mediloop's own plain-English summaries, not the official CPT descriptors, which are owned by the American Medical Association. Whether a charge was correct depends on the record of your visit and your payer's rules.