CPT 99214: office visit, established patient, level 4. What Medicare pays and what to ask
99214 is a higher-level office visit for established patients. This page covers what it means and what Medicare's national rate is.
What this code means
CPT 99214 is used for a visit with moderate medical decision making or at least 30 minutes of total time on the date of the visit.
It sits one level above 99213. The difference in price between the two is one reason the level is worth checking.
Why the bill can be much higher than the Medicare rate
A visit level is chosen by the clinician and the practice's coders, so two similar visits can be billed at different levels.
As with any office visit, tests and procedures are billed separately.
| If a line is billed at | It would be |
|---|---|
| 5x the Medicare rate | $678.05 |
| 10x the Medicare rate | $1,356.10 |
| 20x the Medicare rate | $2,712.20 |
The Medicare rate is a published benchmark, not a legal ceiling on what a provider may charge. Our free scan flags a line as worth a closer look when it is billed at more than 10 times the Medicare rate.
Questions worth asking before you pay
- Why was this visit billed at level 4 rather than level 3?
- Is any test or procedure billed separately on the same date?
- Can I get a copy of the visit codes in writing?
Check every line against the official Medicare rates in about a minute. The scan is free.
Related codes
Source: Medicare Physician Fee Schedule (CMS, July 2026 release), national payment amount, non-facility setting. Last updated October 2026. This page is general information, not legal or medical advice. Rates change each year and a hospital bill can include charges that the benchmark does not cover.