Medicare Part B 2021 Final Rule: Evaluation and Management Changes - Introduction

Effective January 1, 2021, the Centers for Medicare and Medicaid Services (CMS) implemented a new coding, prefatory language, and interpretive guidance framework that the American Medical Association Current Procedural Terminology Editorial Panel issued for office and outpatient E/M visits.

History and exam will no longer be used to select the level of code for office/outpatient evaluation and management (E/M) visits. Instead, an office/outpatient E/M visit will include a medically appropriate history and exam, when performed. The history and exam components will be performed when they are reasonable and necessary, and clinically appropriate.

CPT code 99201 (Level 1 office/outpatient E/M visit, new patient) has been deleted.

For levels two (2) through five (5) office/outpatient E/M visits, selection of the code level to report will be based on the following:

  • Either the level of medical decision-making (as redefined in the new AMA/CPT guidance framework); or
  • The total time personally spent by the reporting practitioner on the day of the visit (including time with and without direct patient contact)

Section 1 - Time (PDF, 148 KB)
Section 2 - Medical Decision-Making Modifications (PDF, 454 KB)
Section 3 - Prolonged Office/Outpatient E/M Visits Services (PDF, 268 KB)
Section 4 - Office/Outpatient E/M Visit Complexity Add-On (PDF, 126 KB)

Last Updated: 01/08/2021