The Centers for Medicare and Medicaid (CMS) finalized implementation of major changes to the E/M codes implemented by the AMA CPT Editorial Panel. Changes take effect January 1, 2021. These changes only apply to the office E/M codes and include an increase in values. Some changes include:

• History and exam no longer used to select the level of code for office and other outpatient visits
• Selection of the code level is based on either the newly defined level of medical decision making (MDM) or total time personally spent by the reporting practitioner on the day of the visit (includes face-to-face and non-face-to-face time) (see Table 1)
• The deletion of new patient code 99201 for 2021
• New prolonged services codes 99417 from CPT and G2212 from CMS for 15-minute increments beyond a level-5 service

Table 1

CPT Code	2020 Work RVU	2021 Work RVU	2021 Day of Encounter Time Range Selection	2021 Typical Total Time
99201	0.48	NA	NA	NA
99202	0.93	0.93	14-29	22
99203	1.42	1.60	30-44	40
99204	2.43	2.60	45-59	60
99205	3.17	3.50	60-74	85
99211	0.18	0.18	NA	7
99212	0.48	0.70	10-19	18
99213	0.97	1.30	20-29	30
99214	1.50	1.92	30-39	49
99215	2.11	2.80	40-54	70
99417/G2212	NA	0.61	NA	15

For additional detailed information regarding new guidelines on time and MDM as well as the other changes to the E/M codes see the AMA website here and here. View archived MedAxiom webinar training sessions on E/M here.

Keywords: ACC Advocacy, Centers for Medicare and Medicaid Services, U.S., Medicare, Medicaid, Outpatients, Decision Making, Current Procedural Terminology, Data Collection

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