10/30/2020

Important Reminder: E&M Changes in 2021

Starting January 1, 2021, there will be significant changes to the office and outpatient Evaluation and Management (E&M) services Current Procedural Terminology (CPT ®) codes (99202-99215), for both new and established patients. 

NEW: 2021 E&M Changes: Time and Prolonged Services

Two new resources regarding the 2021 Evaluation and Management changes are now available on ASCO Practice Central.

"2021 Evaluation and Management Changes: Selecting a Code Based on Time"

Starting on January 1, 2021, providers may select the level of office and outpatient Evaluation and Management (E&M) services based on either time or medical decision making.  In 2021, the definition of time is based on the total time (face-to-face and non-face-to-face) spent by a physician/qualified health care professional (QHP) on the day of the encounter. The time-related rule requiring 50% of the visit be spent on counseling and/or coordination of care to report the service based on time will no longer be applicable as of 2021.  Read more.

"2021 Evaluation and Management Changes: New Prolonged Services Code"

Another major change is the introduction of CPT ® code 99XXX effective January 1, 2021. The code reflects a "prolonged office or other evaluation and management services that requires at least 15 minutes or more of total time either with OR without direct patient contact on the date of the primary E&M service (either CPT® codes 99205 or 99215)". Read more.

Practices, physicians, and staff must prepare in advance for these changes to ensure a successful transition next year and avoid any disruption in reimbursement. Here are nine essential tips to prepare.