New 2021 changes to E/M codes

Effective January 2021, the CPT guidelines for office and outpatient evaluation and management codes (99202-99215) and prolonged services (ie.99354-99356) will change.

The changes only affect office outpatient codes. Observation and inpatient codes remain unchanged. Additional changes you can expect in 2021 include: 

  • CPT guidelines for 1995 or 1997 are no longer used for code selection
  • The requirement to define 3 components for new patient will be removed
  • Code description: Remove language such as "expanded problem focused history", "expanded problem focused examination” and replaced with “medically appropriate history and/or exam".
  • New term descriptors for medical decision making are found in the introduction of the CPT manual.
  • Level determined can based on medical decision making or total face-to-face and non-face-to-face time spent by a Qualified Health Professional.
  • Evaluation and management modifier use and editing does not change.
  • CPT code 99201 has been deleted and will no longer be used.

When using time to determine your CPT level selection

When counting time for the 2021 codes, you should not include time spent on services you report separately. For instance, if you report care coordination using a separate CPT code, you should not include that in the time for the E/M code.

  • The total time also will not include time for activities the clinical staff normally performs.
  • When considering diagnoses to determine decision making, they should be only those relevant to current visit.  
  • Addressing the problem with referral without evaluation (using history, exam, or diagnostic studies) or considering treatment does not constitute decision making.
  • There is a chart defining acute and chronic conditions
  • Add-on code 99417 for prolonged services should only be used in conjunction with 99205/99215
  • While the rules are simpler and allow more flexibility, appropriate and accurate documentation is still required

Additional resources

See the 2021 Medical Decision Making (MDM) table for more information.