{
    "code": "99214",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/99214/2019/A",
    "release_specific_url": "https://localishealth.com/cpt/99214/2019/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 2019?",
        "text": "Medicare paid $110.28 for CPT 99214 in the office (non-facility) setting and $80.01 in a facility under the Q1 2019 Physician Fee Schedule, effective January 2019. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This is a 0.8% increase from the previous quarter."
    },
    "release": {
        "schedule": "pfs",
        "year": 2019,
        "quarter": "A",
        "label": "Q1 2019",
        "effective": "January 1 – March 31, 2019",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 110.28,
        "facility": 80.01,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 1.5,
        "practice_expense_non_facility": 1.46,
        "practice_expense_facility": 0.62,
        "malpractice": 0.1
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 36.0391,
    "source": {
        "label": "Physician relative value file (Q1 2019)",
        "cms_url": "https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu19a.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2019/A",
        "file": "PPRRVU19_V1213.csv",
        "row": 16791,
        "sha256": "027b1b615e25a1c68ccff88175acf40056bc59d858295f8e37b0c5a88a2e7d35"
    },
    "modified_at": "2026-08-04T03:08:45+00:00"
}