E/M Changes in 2021 for 99202-99215 | Overview

• It’s here! New definitions for codes 99202–99215
• Clinicians can select new and established patient visit based on time or medical decision making (MDM)
• New guidelines for using time for 99202—99215, and revised definitions for MDM

The American Medical Association (AMA) CPT^® panel changed the definitions, and CMS is in agreement with these.

The changes below relate only to new and established patient visits in 2021, codes 99202—99215. These changes are in the 2021 CPT book.

• Code 99201 is deleted.
• Clinicians may use either total practitioner time on the date of service or medical decision making to select a code.
• There isn’t a required level of history or exam for visits 99202—99215. The level of history and exam is described as “medically appropriate” and is determined by the clinician.
• Neither history nor exam will be determining factors in selecting the level of service.

“Office or other outpatient services include a medically appropriate history and/or physical examination, when performed. The nature and extent of the history and/or physical examination is determined by the treating physician or other qualified health care professional reporting the service. The care team may collect information and the patient or caregiver may supply information directly (eg, by portal or questionnaire) that is reviewed by the reporting physician or other qualified health care professional. The extent of history and physical examination is not an element in selection of office or other outpatient services.”

• Time is defined as total time spent, including non-face-to-face work done on that day, and  no longer requires the service to be dominated by counseling.
• Visits  have a range for time, e.g., 99213 will be 20-29 minutes, 99214 will be 30-39 minutes
• There are be new definitions within MDM.
• The MDM calculation is similar, but not identical, to the current MDM calculation.
• CPT^® is providing numerous definitions to clarify terms in the current guidelines, such as “chronic illness with exacerbation, progression or side effects of treatment,” and “drug therapy requiring intensive monitoring for toxicity.”  When looking at the single page chart for MDM, reference the definitions in your 2021 CPT book.

All other E/M services that are defined by the three key components will continue to use the 1995 and/or 1997 Documentation Guidelines, not just in 2020, but in 2021. The AMA is continuing to work on changes to other codes, and expects new definitions for them in 2023.

New E/M rules effective date and payer policies

Question:

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

Answer:

The revised definitions for codes 99202—99215 are effective until January 1 2021. These new definitions are now in the 2021 CPT^® book. CMS and the AMA have joined hands (figuratively speaking) in these new definitions for new and established outpatient services. The AMA says that commercial payers are on board with these changes. Use them for all payers.

Members, you can read three in-depth articles about the 2021 changes.

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