99214
Office/outpatient visit, est. patient, mod-high complexity
Office/outpatient visit, est. patient, mod-high complexity is the #6 most-billed Medicaid procedure code, with $29.91B in payments across 502.5M claims from 2018–2024. The national median cost per claim is $53.41.
Total Paid
$29.91B
2.74% of all spending
Total Claims
502.5M
Providers
150K
Avg Cost/Claim
$60
National Cost Distribution
How much do providers bill per claim for 99214? Based on 145K providers billing this code nationally.
Median
$53.41
Average
$58.31
Std Dev
$46.67
Max
$2,220.83
Percentile Distribution (Cost per Claim)
50% of providers bill between $33.58 and $75.33 per claim for this code.
90% bill between $15.38 and $99.32.
Top 1% bill above $188.30.
About This Procedure
HCPCS code 99214 (Office/outpatient visit, est. patient, mod-high complexity) was billed by 150K providers across 502.5M claims, totaling $29.91B in Medicaid payments from 2018–2024. This code was used for 432.9M unique beneficiaries.
Investigation Context
Office visit for an established patient with moderate complexity (99214) is the higher-level counterpart to 99213. Upcoding from 99213 to 99214 is a well-documented fraud pattern — providers bill for a more complex visit than what actually occurred to receive higher reimbursement.
Risk Assessment
This procedure is featured in our investigation: Impossible Volume
Read the full analysis for context on billing patterns associated with this code.
Billing Statistics
Median Cost/Claim
$53.41
Providers Billing
145K
National Spending
$29.91B
Avg/Median Ratio
1.09×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 99214
| # | Provider | Total Paid |
|---|---|---|
| 1 | City Medical Of Upper East Side Pllc New York, NY · Clinic/Center Urgent Care | $108.7M |
| 2 | Fast Pace Medical Clinic Pllc Spring Hill, TN · Family Medicine | $79.9M |
| 3 | Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital | $75.5M |
| 4 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $75.2M |
| 5 | Brightview Llc Cincinnati, OH · Internal Medicine Addiction Medicine | $72.2M |
| 6 | Rector & Visitors Of The University Of Virginia Charlottesville, VA · General Acute Care Hospital | $71.1M |
| 7 | Nextcare Arizona Llc Tempe, AZ · Clinic/Center, Urgent Care | $70.6M |
| 8 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $69.1M |
| 9 | Ideal Option, Pllc Pasco, WA · Preventive Medicine, Addiction Medicine | $66.4M |
| 10 | Presbyterian Healthcare Services Albuquerque, NM · Surgery | $66.2M |
| 11 | Optum Medical Care Of New Jersey Pc Secaucus, NJ · Durable Medical Equipment & Medical Supplies | $65.2M |
| 12 | Umass Memorial Medical Center, Inc. Worcester, MA · General Acute Care Hospital | $61.7M |
| 13 | Montefiore Medical Center Bronx, NY · Anesthesiology | $61.5M |
| 14 | North Shore-lij Medical Pc Great Neck, NY · Urology | $60.8M |
| 15 | Mnr Industries Llc Bel Air, MD · Clinic/Center Urgent Care | $56.8M |
| 16 | Children's Hospital Medical Center Of Akron Akron, OH · General Acute Care Hospital Children | $56.7M |
| 17 | Seattle Children's Hospital Seattle, WA · Prosthetic/Orthotic Supplier | $50.1M |
| 18 | Community Physicians Of Indiana Inc Indianapolis, IN · Internal Medicine | $42.6M |
| 19 | Lsu Health Sciences Center Shreveport Faculty Group Practice Shreveport, LA · Oral & Maxillofacial Surgery | $41.6M |
| 20 | Waianae District Comprehensive Health And Hospital Board, Inc Waianae, HI · Pediatrics | $41.4M |
Showing top 20 of 150K providers billing this code