Overview of E&M Changes for Outpatient CPT codes 99202-99215 for 2021

• CPT code 99201 has been deleted
• CPT is changing the definitions and documentation requirements for new and established outpatient codes.
• Providers may select new and established codes based on either Total Time or Medical Decision Making Elements.
• Office or other outpatient services will include a medically appropriate history and or physical exam when performed. The nature and extent of these elements is determined by the physician or other QHCP. The content of HPI and Exam will not contribute in support in code selection of office or other outpatient services.
• Services billed based on Time:
  • Is defined as total time. Including non-face-to-face work done on that same date of service.
  • Time is no longer defined as time spent on counseling and coordinating care.
  • Code will be assigned a time range. (See time threshold table below).
  • Face to Face time is still a requirement for the billing provider.
  • Time spent for services that are separately reported may not be included in the total time.
  • CPT will release a NEW Prolonged service code as an add-on code only for level of service 99205 and 99215 when the time limit is exhausted.
• CPT is publishing new definitions within the Medical Decision Making component. The MDM calculation will look similar to but not exactly like the current guidelines. The requirements for 2021 with respect to billing based on MDM are outlined in the second and third table below. 

All other Evaluation and Management that are currently defined by three key components (Inpatient services, ED visits, SNF visits, etc.) will continue with the current 1995 or 1997 documentation guidelines, however the CPT E/M panel is working on other code sets for future years.