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
How much more does a 99214 pay than a 99213?
It varies by payer, but the per-visit difference is meaningful and compounds fast across a full panel — which is why systematic under-coding is expensive.
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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