CodeReflex An Honest Calculator
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What did you leave on the table last year?

A conservative estimate of E/M undercoding losses, built on 2025 Medicare data and peer-reviewed research. No signup. No email. Just the number.

Four questions · 60 seconds · Sources cited

01
What's your specialty?
How many patients do you see on a typical clinical day?
10203040+
22
When you're on the fence between a 99213 and a 99214, which do you tend to pick?
Be honest. Most physicians lean one way.
How many years have you been in practice? Optional
Used only to estimate cumulative loss. Skip if you'd rather not.
0102035+
10 yrs
No signup. Results stay in your browser.
Your Estimate

Based on a conservative interpretation of peer-reviewed undercoding research and 2025 Medicare rates.

$0
Estimated annual loss · floor estimate
$0
Per month
$0
Per clinical day
$0
Cumulative
How we got there
Clinical days per year220
Estimated annual visits0
Visits coded 99213 (specialty avg.)0
Likely 99214-level under 2023 MDM0
Reimbursement delta per visit (Medicare)$37

Commercial payers reimburse roughly 110–140% of Medicare.

Methodology & sources

Reimbursement rates. We use 2025 Medicare Physician Fee Schedule national non-facility averages. 99213 ≈ $89, 99214 ≈ $126 — a difference of approximately $37 per visit. We do not adjust for geographic locality. Commercial payers typically reimburse 110–140% of Medicare, so this estimate is a floor.

Undercoding prevalence. We anchor to peer-reviewed primary care data, using the most conservative figures available.

Among attending family physicians in a 2019 peer-reviewed study, 40.3% of visits coded at 99213 or lower could have been legitimately coded at 99214 or higher. Among residents, the rate was 88.7%. → Young et al., Residency Research Network of Texas, Family Medicine, 2019. PMID: 31013346
CMS utilization data on 38.2 million family medicine established-patient visits showed 42% coded as 99213 and 50% as 99214, with a per-visit reimbursement delta of approximately $35. → AAFP, Family Practice Management, citing CMS 2016 utilization tables

Conservatism choices we made. We do not assume any 99214 → 99215 undercoding (which would raise the number further). We assume 220 clinical days per year (4.25 days/week × 52 weeks, minus 1 week of conference and 4 weeks of vacation). We apply only a fraction of the 40.3% attending undercoding rate, adjusted by your self-reported coding tendency. Cumulative loss does not adjust for fee schedule changes over time.

What this estimate does not include. Missed modifier-25 opportunities. 99215 undercoding. Documentation issues that lead to downcoding by auditors. Time-based coding under 2021/2023 rules. Prolonged service codes. Add-on codes. Each of these is a separate revenue category. The number you see is likely a significant underestimate.

What this estimate is not. A guarantee. An audit. Legal or billing advice. It is a defensible order-of-magnitude estimate, built to be conservative and citable.

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CodeReflex uses 2023 AMA MDM logic to flag undercoding in real time, with full MDM reasoning. A 99214 instead of a 99213 — once — covers Pro for the month. Built by an active pediatric urgent care physician, not a software company.

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