E/M changes set for 2021

July 17, 2020
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CMS changes to E/M Office/Outpatient Codes (99201-99205, and 99211-99215) will be in effect    starting January 1, 2021.

Overview

  • Providers may select new and established patient visit level of service based on time or medical decision making (MDM)
  • Code 99201 will be deleted
  • New time guidelines 99202—99215. Time will be defined as total time spent, including non-face-to-face work done on that day, and will no longer require time to be dominated by counseling.
  • Visits will have a range for time, e.g., 99213 will be 20-29 minutes, 99214 will be 30-39 minutes
  • Revised MDM guidelines
  • There will be no required level of history or exam for visits 99202—99215.
  • All other E/M services that are defined by the three key components will continue to use the 1995 and/or 1997 Documentation Guidelines.
  • To date, only Medicare is committed to the E/M changes.
  • Only Office/Outpatient E/M codes are impacted by the changes.

What to do to prepare?

  • Provider Education and Training
  • Revise Policies and Procedures
  • EHR and template updates
  • Assess financial impact