The 2020 physician fee schedule finalized changes in evaluation and management (“E/M”) codes that became effective Jan.1, 2021. It quickly became evident from provider feedback that clarification was needed.
The American Medical Association published technical corrections and hosted a webcast to help clarify specific areas of confusion.
This is the first article in a three-part series that provides a summary of the changes to the E/M services as approved by AMA’s CPT Editorial Panel.
E/M code selection can now be based on either time or medical decision-making. The focus in this article is on the rules for time.
- Requires a face-to-face encounter with a physician or qualified health professional (QHP).
- Includes the total provider time required to assess and manage the patient on the date of the encounter, including non-face-to-face services; and
- Only the time of one provider should be counted when two or more providers jointly meet with/discuss the patient.
|New patient office visits|
|99202||15 – 29 minutes|
|99203||30 – 44 minutes|
|99204||45 – 59 minutes|
|99205||60 – 74 minutes|
|Established patient office visits|
|99212||10 – 19 minutes|
|99213||20 – 29 minutes|
|99214||30 – 39 minutes|
|99215||40 – 54 minutes|
Note: 99211 describes a visit that does not require the presence of a physician; therefore, time cannot be used for this code.
The AMA’s technical corrections provided the following clarifications regarding the calculation of time. Time spent on the following should not be included in the calculation of time:
- Performing other services that are reported separately (ex: radiology service ordered separately at this visit or previously counted by someone else in your group and specialty).
- Teaching that is general and not limited to the discussion that is required for the management of a specific patient.
Based on this, time spent reading allergy skin testing results, for example, should not be counted because that work is included in the skin testing codes.
PROLONGED TIME: Total time on the date of the encounter for services provided by a physician or QHP for face-to-face and non-face-to-face time. It can only be used with level 5 visit codes 99205 or 99215.
|New patient – Non-Medicare|
|99205, 99417||75 – 89 minutes|
|99205, 99417 x 2||90 – 104 minutes|
|99205, 99417 x 3||105 – 119 minutes|
|New patient – Medicare|
|99205, G2212||89 – 103 minutes|
|99205, G2212 x 2||104 – 118 minutes|
|99205, G2212 x 3||119 – 133 minutes|
|99215 + 99417||55 – 69 minutes|
|99215 + 99417 x 2||70 – 84 minutes|
|99215 + 99417 x 3||85 – 99 minutes|
|Established Medicare Patient|
|99215 + G2212||69 – 83 minutes|
|99215 + G2212 x 2||84 – 98 minutes|
|99215 + G2212 x 3||99 – 113 minutes|
For more details about using time when calculating E/M codes, please view our previous Advocacy Insider article, 2021 E/M coding and documentation rules. The College will be hosting an E/M coding webinar on July 13 – get more information and register for the webinar today!
Watch for the next Advocacy Insider as we discuss technical corrections for medical decision-making as they relate to coding for E/M services. The Advocacy Council – we have you covered.