CPT (Current Procedural Terminology) codes are numbers assigned to services that medical practitioners provide to patients. Insurers use the CPT codes to calculate the reimbursement that a medical practitioner will receive for their service(s).
The first version of the American Medical Association (AMA) CPT codes was published in 1966 (source). It was a means to code procedures for medical records, claims, and information primarily for statistical purposes. By 1970, the American Medical Association had broadened the CPT system to include diagnostic and therapeutic procedures in surgery, medicine, and specialties as well as medical procedures relating to internal medicine. It wasn’t until 1983 that the CPT coding system was adopted as a part of the Centers for Medicare & Medicaid Services (CMS) system.
The time interval for the release of new category CPT codes varies from one category to another. New Category I CPT codes are released annually, Category II codes are released thrice a year, and New Category III CPT codes are released biannually.
Common CPT Codes for Family Practice
The most common CPT (Current Procedural Terminology) codes used by family practitioners are 99213 and 99214. According to CMS, family physicians provided a staggering number of established patient visits which was 38,249,187 in the year 2016. Out of these 38.2 million patient visits, approximately 42% were reported as 99213 visits, and approximately 50% were reported as 99214 visits (source).
The CPT system and CMS (Centers for Medicare & Medicaid Services) Evaluation & Management rules state that 99213 can be used if a physician treats a patient for one stable chronic condition and 99214 can be used if they see a patient with one chronic disease not in optimal control.
It’s important to note that family practice medical billing CPT Code reimbursement rates vary by location, insurance company, network status, license, etc. You can check the latest Medicare physician fee schedules in the CMS database here.
According to the American Academy of Pediatrics(AAP), 99213 lists a typical physician’s time of 15 minutes face to face with the patient and/or family, while 99214 has a typical physician’s time of 25 minutes (source). Notably, the times are averages, not thresholds, so a physician should select the code closest to the time spent. For example, if the total duration of face-to-face time is 18 minutes, you should select code 99213 because the duration of the visit is closer to 15 minutes, the average time for a 99213, than is to 25 minutes, and the average time for a 99214.
Let’s take a quick look at these two common CPT Billing Codes below.
CPT Code 99213
The CPT code 99213 as maintained by the American Medical Association (AMA), is a medical procedural code under the range Established Patient Office or Other Outpatient Services involving patient evaluation and management. The 99213 visit involves a low level of medical decision making and/or the provider spends 20–29 minutes of total time on the encounter on a single date. The presenting problem(s) involving this CPT code is usually of low to moderate severity.
CPT Code 99214
Just like the CPT Code 99213, the CPT Code 99214 is a medical procedural code under the range Established Patient Office or Other Outpatient Services. This CPT code is applied for the evaluation and management of an established patient, involving at least two of these three key components: a detailed history, a detailed examination, and medical decision-making of moderate complexity.