I see my follow-ups for 30-minutes, and I'm having a hard time seeing in my mind how I don't end up billing most of my follow-up visits as level 4 (99214) visits with a psychotherapy add-on code (90833). I am doing psychotherapy for more than 16 minutes with most of my patients, and if you look at the criteria for a level 4, it's hard not to hit that threshold. Legitimately, any patient with 3 chronic illnesses (e.g, MDD, Anxiety NOS, Insomnia) is a level 4 visit: E.g., 3 stable illnesses = 3 problem points = moderate complexity (AND) 2 stable chronic illnesses with meds = moderate risk/ medical decision making ultimately ___________________________________________________ = 2/3 categories for moderate complexity (level4) and simply ignore data points That said, the recommended time for a level 4 visit is 25 -minutes, which seems more fitting of a PCP office where you may see the patient once every 3-6 months and not when you know your patient extremely well--not that CMS or Medicaid may care. I am trying to decide whether I should be concerned for a potential audit in billing in this fashion, which seems justified based upon medical decision making criteria and by time spent in psychotherapy. My documentation is fine. The only variable out there that concerns me is the recommended time for a level 4 visit, which is 25-minutes, noting that I am NOT typically billing based upon time alone, and then I would not be using an add-on code. I do bill level 3s, and I do have no-shows. I don't do therapy with everyone. Still, the idea of an audit scares me in concept alone, though I have no doubt my documentation would be fine.