Does CPT Code 99214 Need a Modifier?
On its own, CPT 99214 does not always require a modifier. However, in many scenarios, especially when billing it with other procedures or services, modifiers become essential for correct reimbursement.
When to Use a Modifier with 99214
You should apply a modifier if:
- You’re billing 99214 with a psychotherapy code like 90833 → Use Modifier 25.
- You perform a procedure on the same day as the E/M service → Use Modifier 25.
- The service was unrelated to a previous visit (e.g., post-op complication) → Use Modifier 24 (if applicable).
Common Modifiers for 99214
| Modifier | Description | Example Use Case |
| 25 | Significant, separately identifiable E/M service | Billing 99214 and 90833 together |
| 24 | Unrelated E/M by same provider during post-op | Follow-up for a new issue during global period |
| 57 | Decision for surgery | Used with E/M that leads to surgery next day |
Why Modifier 25 is So Important
Modifier 25 is often used incorrectly or not at all, leading to claim denials or underpayments. Always ensure the E/M service is separate and well-documented to justify its use.
Documentation Tips
- Separate the E/M portion from any other procedure notes.
- Clearly state that both services were medically necessary.
- Note time spent and actions taken for each service.
Avoid These Mistakes
- Using a modifier without justification.
- Forgetting to use a modifier when required.
- Assuming all visits need a modifier — not always true.
Conclusion
CPT 99214 may need a modifier in certain situations, especially when billed with additional services like psychotherapy. Using the right modifier—especially Modifier 25—can mean the difference between full payment and a denial.
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