While not all insurance companies accept the code 99214, many do. In fact, some medical and psychiatry practice may be “leaving money on the table” when they bill a 99213 code when in fact their service meet the criteria of a 99214 code.

To meet the criteria of a 99214 code / service, a medical service must meed the following requirements: 

  1. The patient being serves is an established patient. It is not his/her first visit
  2. The service must be an outpatient visit, meaning the service does not incorporate inpatient or hospital care
  3. The service must meet or exceed two of the following three sub-criteria:
    A) a detailed medical history is documented
    B) a detailed medical exam is provided
    C) the medical decision making entails at least moderate complexity
    4. The severity of the presenting problem must be moderate to high

  4. 5. The doctor and the patient should have a minimum 25 minutes face time
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    Anthony Centore

    Anthony Centore Ph.D. is Founder and CEO at Thriveworks--a counseling practice, focused on premium client care, with 240+ locations across the USA. He is Private Practice Consultant for the American Counseling Association, columnist for Counseling Today magazine, and Author of How to Thrive in Counseling Private Practice. Anthony is a multistate Licensed Professional Counselor and has been quoted in national media sources including The Boston Globe, Chicago Tribune, and CBS Sunday Morning.

    Check out “Leaving Depression Behind: An Interactive, Choose Your Path Book” written by AJ Centore and Taylor Bennett."