Difference Between 99212, 99213, 99214, and 99215

CPT codes 99212, 99213, 99214, and 99215 are commonly used Evaluation and Management (E/M) codes for established patient office or outpatient visits. While they may seem similar, each code represents a different level of medical decision-making, time, and complexity. Understanding the differences is essential for accurate documentation, coding compliance, and proper reimbursement.

What Are 99212–99215 CPT Codes?

These CPT codes are used to report face-to-face or telehealth visits with established patients in office or outpatient settings. Since the 2021 E/M updates, these codes are selected based on either:

• Medical Decision Making (MDM) or
• Total time spent on the date of the encounter

History and physical exam are still required but are no longer used to determine the code level.

Quick Comparison Table

Detailed Breakdown of Each Code

CPT 99212

Lowest-level established patient visit

• Used for minor or self-limited problems
• Minimal risk and straightforward decision-making
• Often involves simple follow-ups or brief consultations

Common examples:

• Medication refill with no changes
• Minor symptom check with no new findings

CPT 99213

Most frequently used established patient code

• Low-level medical decision-making
• Stable chronic conditions or uncomplicated acute issues
• Limited data review and low risk

Common examples:

• Controlled hypertension follow-up
• Uncomplicated urinary tract infection

CPT 99214

Moderate-complexity visit

• Management of multiple chronic conditions
• New problems requiring evaluation
• Moderate risk of complications or treatment changes

Common examples:

• Diabetes with medication adjustment
• Multiple chronic conditions requiring coordination

CPT 99215

Highest-level established patient visit

• High-complexity medical decision-making
• Serious or worsening conditions
• Significant data review and high risk of morbidity

Common examples:

• Complex care planning
• Severe disease management with multiple treatment options

Key Differences Explained

1. Medical Decision Making (MDM)

Each higher code reflects:

• More problems addressed
• Greater data reviewed
• Higher risk of complications

2. Time Spent

Time includes:

• Reviewing records
• Examining the patient
• Ordering tests
• Counseling and care coordination
• Documenting the visit

Only time spent on the day of the encounter counts.

3. Risk Level

As you move from 99212 to 99215, the clinical risk and provider responsibility increase.

Common Coding Mistakes to Avoid

• Upcoding without proper documentation
• Selecting codes based on history or exam level alone
• Miscalculating time spent
• Ignoring MDM requirements

Accurate documentation is critical to support the chosen code.

Final Thoughts

The difference between 99212, 99213, 99214, and 99215 lies in complexity, time, and risk—not just visit length. Selecting the correct E/M code ensures compliance, reduces audits, and supports appropriate reimbursement.