American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Have questions about office/outpatient E/M coding? Contact the ACS Coding HotlinePhysicians and other practitioners who are paid under the Medicare Physician Fee Schedule (MPFS) bill for common office or other outpatient visits for evaluation and management (E/M) services using a set of Current Procedural Terminology (CPT)* codes that distinguish visits based on the level of complexity, site of service, and whether the patient is new (CPT codes 99201-99205) or established (CPT codes 99211-99215).

For the first time since it was introduced in 1992, the office/outpatient E/M CPT code set has been extensively revised, including the  addition of a new code to report incremental time associated with prolonged office or other outpatient services.

Effective January 1, 2021, new reporting guidelines will be implemented and code selection for office/outpatient E/M services will be based on:

Coding for Office/Outpatient E/M Services (2021)

2021 Code Descriptors

Descriptors and related elements for code selection for office/outpatient E/M visits have been updated for 2021. 

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Reporting Guidelines

New rules have been created for selecting and reporting office/outpatient E/M code levels.

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History & Examination

History and physical examination requirements have been eased for office/outpatient E/M reporting.

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Time

Total time on the date of the encounter may be used for office/outpatient E/M code selection.

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MDM

The level of MDM for office/outpatient E/Ms is based on 2 out of 3 elements for both new and established patients.

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ACS Advocacy

The ACS has engaged in extensive advocacy efforts related to E/M changes.

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*All specific references to CPT codes and descriptions are © 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.