What's the difference between a 99213 and a 99214?

Since 2021, the difference comes down to medical decision-making (MDM) or total time on the date of service. A 99214 requires moderate-complexity MDM, or the higher time threshold, documented; a 99213 is low-complexity. Under-coding a documented 99214 as a 99213 is one of the most common quiet revenue losses in primary and specialty care.

What actually matters

• 99214 = moderate-complexity MDM or the higher total-time threshold, documented
• 99213 = low-complexity MDM
• MDM is driven by the problems addressed, the data reviewed, and the risk
• When billing on time, state the total time explicitly in the note
• Under-coding is as costly as over-coding, and far more common

Common questions

Where Volari fits: When a payer downcodes a documented 99214 to a 99213, Volari catches it by comparing the billed code to the paid code.

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