National Government Services’ Medical Review of CPT 99214

The Advocacy Council received notice that the National Government Services’ (NGS) Medical Review department will be focusing on CPT 99214 in Connecticut, Massachusetts and New York. Their recent routine analyses of data indicates 99214 has one of the highest Comprehensive Error Rate Testing scores within the evaluation and management services.

Records will be automatically requested before claims are paid.  Documentation for the specific date of service should include health care provider’s progress notes, orders, medication records, procedure/operative reports, relevant diagnostic/operative reports, or documentation of time that would assist in supporting the services submitted. Unsigned notes will delay processing times.

We strongly recommend you review the definition and requirements of CPT 99214, making sure your documentation reflects each point. Be sure to respond to any requests for records in a timely manner. Additional information is available.

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