What is the difference between 99213 and 99214?

For established outpatient visits, 99213 reflects low-complexity medical decision making (or 20 to 29 minutes of total time), and 99214 reflects moderate-complexity medical decision making (or 30 to 39 minutes). The higher level requires more complex problems, data, or risk, or more time.

Learn · Coding fundamentals

E/M leveling: 99213 vs 99214 and the 2021 rules

Q: What is E/M leveling?

E/M leveling is choosing the correct evaluation and management code level for a visit based on its complexity. For office and other outpatient visits (99202 to 99215), the level is selected by medical decision making or total time.

By the Capsa Coding team Last updated June 3, 2026 Reviewed against primary sources (AMA CPT, AAFP, CMS)

Quick answer

E/M leveling is choosing the right evaluation and management code level for a visit based on its complexity. For office and other outpatient visits (99202–99215), the 2021 rules let you select the level by either medical decision making (MDM) or total time — history and exam are still documented when medically appropriate but no longer determine the level. For established patients, 99213 reflects low-complexity MDM (or 20–29 minutes) and 99214 reflects moderate-complexity MDM (or 30–39 minutes).

What the 2021 change did

Effective January 1, 2021, CMS and the AMA overhauled outpatient E/M — the first major change in about 25 years. The point was to reduce documentation burden: instead of counting history and exam “bullets,” you now select the level by medical decision making or total time. History and exam are still performed and documented when medically appropriate, but they no longer drive the code.

99213 vs 99214 (established patient)

	99213	99214
MDM	Low complexity	Moderate complexity
Total time	20–29 minutes	30–39 minutes
Typical picture	A stable problem or a straightforward acute issue	Chronic illness with progression, a new problem with workup, or higher risk

You can level by either method — whichever best reflects the visit — and document accordingly.

How MDM is judged

Medical decision making is assessed across three elements: the number and complexity of problems addressed, the amount and complexity of data reviewed, and the risk of the management options. The level is set by meeting two of those three at the given complexity.

Scope & accuracy: CPT and its guidelines are owned by the AMA; this summarizes the rules and doesn't reproduce them verbatim, and payer policies vary. Educational, not coding advice — verify against current CPT and payer rules. Capsa's live skills are pediatric ambulatory vaccine administration and screening; E/M-level coding (Capsa E&M Coding) is on the roadmap and not yet generally available.

The principle behind defensible leveling

Whichever method you use, a defensible E/M level is one the documentation actually supports — the MDM or the time is in the note, not just in the coder's head. That evidence-first principle — every code tied to what the chart says — is the same one Capsa is built on for its live categories, and the one a future Capsa E&M Coding product would extend to leveling. (See the suite roadmap.)

Frequently asked questions

What is E/M leveling?+

Choosing the correct evaluation and management code level for a visit based on its complexity. For office and other outpatient visits (99202–99215), the level is selected by medical decision making or total time.

What changed in 2021 for outpatient E/M coding?+

Effective January 1, 2021, outpatient E/M levels are chosen by either MDM or total time. History and exam are still documented when medically appropriate but no longer determine the level — the first major change to office E/M in about 25 years.

What's the difference between 99213 and 99214?+

For established outpatient visits, 99213 reflects low-complexity MDM (or 20–29 minutes), and 99214 reflects moderate-complexity MDM (or 30–39 minutes). The higher level requires more complex problems, data, or risk — or more time.

Can you select an E/M level by time?+

Yes. Since 2021, total time on the date of the encounter is a valid basis for selecting the outpatient E/M level, as an alternative to MDM. You choose whichever method best reflects the visit, and document accordingly.

Sources

American Medical Association, CPT Evaluation and Management (E/M) revisions. ama-assn.org
American Academy of Family Physicians (AAFP), “Outpatient E/M Coding Simplified.” aafp.org