New E/M rules effective date and payer policies

Question:

Can we start using the new E/M rules for new and established patient visits in January? And, are all payers going to follow them?

Answer:

No, the revised definitions for codes 99202—99215 are not effective until January 1 2021. When the AMA released the revised E/M guidelines, it specifically said that the code changes would not be included in the 2020 CPT^® book. The definitions and documentation requirements for codes 99201—99215 are unchanged in 2020.

Although some would like to jump ahead and implement the changes right away, we have a year to prepare.

CMS and the AMA have joined hands (figuratively speaking) in these new definitions for new and established outpatient services. When CMS published their proposed rule in July 2019, they rescinded the proposal for blended payments and a single RVU value for levels 2-4 new patients and level 2-4 established patients for 2021. Instead, they endorsed the CPT^® guidelines for 2021.

Because the changes to these codes are written in the CPT ^®book, I would expect that commercial payers will use the new CPT^® definitions for these codes in 2021.

You can download and read the CPT^® article here.

The CPT E/M changes coming in 2021 were the topic of our August 2019 webinar which is available on-demand.

 

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