The American Medical Association (AMA) has published the largest revisions in 25 years to the codes and guidelines for office and other outpatient evaluation and management (E/M) services. Many of these changes will fundamentally alter how billers code in the future and are crucial to incorporate so that your practice may avoid any denials.

The changes to CPT codes ranging from 99201-99215 are proposed for adoption by the Centers for Medicare and Medicaid Services on Jan. 1, 2021. They include:

New Patient:

• 99202– Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straight forward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.
• 99203– Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.
• 99204– Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter.
• 99205– Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter.

Established Patient:

• 99211– Office or other outpatient visits for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.
• 99212– Office or other outpatient visits for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of the total time is spent on the date of the encounter.
• 99213– Office or other outpatient visits for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of the total time is spent on the date of the encounter.
• 99214- Office or other outpatient visits for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and a moderate level of medical decision making. When using time for code selection, 30-39 minutes of the total time is spent on the date of the encounter.
• 99215- Office or other outpatient visits for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and a high level of medical decision making. When using time for code selection, 40-54 minutes of the total time is spent on the date of the encounter.

For more information visit: https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf