What is changing in 2021

• 1995 and 1997 E/M selection guidelines are retired

• History and examination have been eliminated as “key”
components for code selection
• New selection guidelines:
• Total time for the date of the encounter
OR
• Medical decision making (MDM)

7
 What CPT codes are affected?
• CPT code 99201 has been deleted for use
• Office and outpatient evaluation and management codes
(99202-99215) descriptions have been revised
• Prolonged services (ie. 99354-99356)

8
 Billing provider time
• Counseling and/or coordination of care will no longer
dominate
• Excludes time spent on services you report separately
• Will not include activities the clinical staff normally performs
• Shared/split visit: the sum of time spent by both providers for
one encounter

9
 New patient timetables explained

New patient E/M Typical time (2020) Total time range

code (2021)

99201 10 minutes Code deleted

99202 20 minutes 15 – 29 minutes
99203 30 minutes 30 – 40 minutes
99204 45 minutes 45 – 59 minutes
99205 60 minutes 60 – 74 minutes

10
 Established patient timetables explained

New patient E/M Typical time (2020) Total time range

code (2021)

99211 5 minutes Time component

removed
99212 10 minutes 10 – 19 minutes
99213 15 minutes 20 – 29 minutes
99214 25 minutes 30 – 39 minutes
99215 40 minutes 40 – 54 minutes

11
 Medical Decision Making (MDM)
• CPT® clarified and expand the MDM guidelines
• The 2021 MDM table will have three main columns
– Code
– Level of MDM (based on 2 out of 3 elements of MDM)
– Elements of MDM
• Number/complexity of problems addressed
• Amount and/or complexity of data to be reviewed/analyzed
• Risk of complications/morbidity/mortality of patient
management
• Level of Medical Decision Making (MDM) table
12
 Prolonged services
• Codes +99354 and +99355 for prolonged E/M services
requiring direct patient contact will change from applying to
the office or other outpatient setting to applying to the
outpatient setting
• Add-on code 99417 for prolonged services should only be
used in conjunction with 99205/99215

13
 Prolonged service example

Total duration of new patient Code(s)

office or other outpatient
services
(use with 99205)
Less than 75 minutes
75 – 89 minutes
90 – 104 minutes
105 minutes or more
Not reported separately
99205 X 1 and 99417 X 1
99205 X 1 and 99417 X 2
99205 X 1 and 99417 X 3 or more
for each additional 15 minutes.

14