CPT 99214: Office/Outpatient Visit — Established Patient, Level 4
An established-patient office visit with moderate to high complexity medical decision making — a longer, more involved appointment.
Category: Office Visit | Typical bill: $150 - $350
⚠️ Prior authorization: No
🎯 Am I being overcharged?
Enter what your bill says for CPT 99214 and we'll flag it against a typical fair range for this service.
Why your Office/Outpatient Visit — Established Patient, Level 4 bill looks so high
Hospitals bill a "rack rate" that is often 2-10x higher than what Medicare pays or what insurers actually reimburse. The fair range for CPT 99214 is roughly $150 - $350 — but many facilities bill far beyond it.
Common reasons 99214 claims get denied
- Downcode dispute — billed Level 4 when notes support Level 2/3. Level 4 requires moderate complexity AND typically ~30+ minutes. Compare chart notes to the billed level.
99214 vs 99213 is one of the most audited billing boundaries. Ask for the note to confirm the level is supported.
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