02/19/2021

Important Reminders: Evaluation and Management Services in 2021

Consultations, Hospital Inpatient Services, Hospital Observation Services
As of January 1, 2021, CPT codes 99202-99215 should be selected based on time or medical decision making. However, the new guidelines do not apply to other E/M services such as consultations, hospital inpatient services, and hospital observation services. Be sure to review the new guidelines in the AMA CPT® Professional Edition manual.

Prolonged Services
CPT codes 99354 and 99355 (prolonged services with direct patient contact) may no longer be reported with office or outpatient E/M services 99202-99215. A prolonged service with or without direct patient contact on the same day as an office or outpatient E/M should be reported with either CPT code 99417 or HCPCS code G2212.

Add on Complexity Code
In the 2021 Medicare Physician Fee Schedule (PFS), Medicare had intended to establish payment for HCPCS code G2211 (visit complexity inherent to office/outpatient E/M services…part of ongoing care related to a patient’s single, serious, or complex condition). However, the Consolidated Appropriations Act delayed PFS payment for G2211 until January 1, 2024. HCPCS code G2211 has been assigned a payment indicator status of “B.” Therefore, there will not be any separate reimbursement for this service until 2024 (unless advised otherwise).

For more information on these changes, please see ASCO’s Guide to the 2021 Evaluation and Management Changes.