99213 or 99214 depends on medical decision making or time
Two stable chronic illnesses with prescriptions you manage support a 99214 by medical decision making. So do 30 minutes of your time on the date.
Head of Growth and Operations, JotPsych
You refilled two prescriptions today, one for stable depression and one for stable insomnia. You're about to bill the visit as a 99213.
Count the problems you addressed first. At Medicare's 2026 national rates, a 99214 pays a nurse practitioner $34.36 more than a 99213 does, and pays a physician $40.42 more.
Depression: stable on the current dose.
Antidepressant refilled, no change.
Code: 99213
Depression: stable on the current dose.
Insomnia: stable on the current dose.
Antidepressant and sleep medication refilled, no change.
Code: 99214
Both notes describe the same visit, and Note A leaves out the insomnia and its refill. Note B shows two stable chronic illnesses and prescription drug management, so Note B reaches moderate on two of three elements and supports a 99214.
Bill a 99213 for one stable illness with a refill
The American Medical Association table rates three elements of medical decision making (MDM): the problems, the data, and the risk. Two of the three set the level.
One stable chronic illness is a low-level problem. Managing its prescription is moderate risk. With little data to review, only the risk reaches moderate, so the visit stays at low medical decision making, a 99213.
For that visit, Medicare's 2026 national rate is $80.91 for a nurse practitioner, 85% of the physician rate of $95.19. PayerPrice puts Cigna's national average for a 99213 at $101.25 and Aetna's at $82.03. Neither average names a clinician type.
Bill a 99214 for two stable illnesses with refills
Count the insomnia, too. Two or more stable chronic illnesses reach the moderate level for problems, so with the prescriptions you manage, two of your three elements sit at moderate. You're now at a 99214, which Medicare's 2026 national rates put at $115.27 for a nurse practitioner and $135.61 for a physician.
One chronic illness that's getting worse, or that has side effects from treatment, also puts the problems at moderate.
Medicare's 2026 national rates pay more for a 99214 than for a 99213, for a nurse practitioner and for a physician. A visit that supports a 99214 but goes out as a 99213 loses the difference.
Bill either code by time
You can also use time. Medicare counts your total time on the date, including the time you spend reviewing tests, ordering medications, documenting your note, and coordinating care. The code descriptors set 20 minutes for a 99213 and 30 for a 99214, so put your start and stop times or your total time in each note.
Count the problems you address and add up your time before you bill. Bill the higher level that your decision making or your time supports.
Set the start time and duration in Time on note & claim, and JotPsych uses that time for billing.
Book 15 minutes- Centers for Medicare & Medicaid Services, PFS Relative Value Files: 2026 national physician rates and short descriptors (such as "Office o/p est mod 30 min") from the October 2026 release (RVU26D), file PPRRVU2026_Oct_nonQPP, conversion factor 33.4009.
- Legal Information Institute, Cornell Law School, 42 U.S.C. 1395l(a)(1)(N) and (O): Medicare pays 80 percent of the lesser of the actual charge and the fee schedule amount for a physician's service, and 80 percent of "the lesser of the actual charge or 85 percent of the fee schedule amount" for a nurse practitioner's, read October 2, 2026.
- American Medical Association, CPT evaluation and management office visit revisions, Table 1: Levels of Medical Decision Making, effective January 1, 2021.
- Centers for Medicare & Medicaid Services, Medicare Learning Network, Evaluation and Management Services (MLN006764), May 2026.
- PayerPrice, CPT 99213 fee schedule by payer, national averages by payer, last verified October 2026; the page names no clinician type.