{
    "code": "99214",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/99214/2016/A",
    "release_specific_url": "https://localishealth.com/cpt/99214/2016/A",
    "description": "A more involved established-patient visit — for example, managing multiple chronic conditions that are not fully controlled (such as diabetes needing a medication change), or a new problem with an uncertain diagnosis that requires prescription drug management. Total visit time typically runs about 30 to 39 minutes. Documentation needs to support a higher level of decision-making: more than one chronic illness with exacerbation, or moderate risk from the treatment plan, such as starting or adjusting a prescription drug.",
    "answer": {
        "question": "How much did Medicare pay for CPT 99214 in Q1 2016?",
        "text": "Medicare paid $108.13 for CPT 99214 in the office (non-facility) setting and $79.13 in a facility under the Q1 2016 Physician Fee Schedule, effective January 2016. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This is a 0.7% decrease from the previous quarter."
    },
    "release": {
        "schedule": "pfs",
        "year": 2016,
        "quarter": "A",
        "label": "Q1 2016",
        "effective": "January 1 – March 31, 2016",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 108.13,
        "facility": 79.13,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 1.5,
        "practice_expense_non_facility": 1.42,
        "practice_expense_facility": 0.61,
        "malpractice": 0.1
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 35.8043,
    "source": {
        "label": "Physician relative value file (Q1 2016)",
        "cms_url": "https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu16a.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2016/A",
        "file": "PPRRVU16_V0122.csv",
        "row": 16129,
        "sha256": "e7973024293c4f8bd19119f0479a6b7bdc36435376c6b05a22fd3cd3cec5b13c"
    },
    "modified_at": "2026-08-04T03:06:29+00:00"
}