2021 has arrived, which means so have changes to the code set. The American Medical Association reported that overall there are 328 editorial changes, including 206 new codes, 54 deletions, and 69 revisions. The AMA has also stated that these changes include the “first major overhaul of office visit and outpatient E/M coding” since the mid-1990’s.

Office visit codes 99201 through 99215 have eliminated the history and physical exam element and enable physicians to select code levels based on medical decision-making or total time spent with the patient. When selected based on time, the code includes both face-to-face and non-face-to-face time spent by the provider.

Activities that may count toward time-related E/M codes include:

  • Reviewing tests in preparation for a patient’s visit.
  • Counseling or educating a patient, family or caregiver.
  • Reporting test results to a patient by phone.
  • Ordering medications, tests or procedures.
  • “Pajama time” documentation work performed at home.

These changes are expected to be adopted by the centers for Medicare and Medicaid services, effective January 1, 2021.


New Patient CPT Codes

99202 – 99205: no longer require the 3 key components or reference typical face-to-face time. Instead, each service includes “a medically appropriate history and/or examination,” and code selection will be based on the level or total time spent on that date. 99201 has been deleted for 2021.

Code History/Exam MDM Total Minutes
99202 Medically appropriate history and/or examination Straightforward 15-29
99203 Low 30-44
99204 Moderate 45-59
99205 High 60-7


Established Patient CPT Codes

99211: Level 1 established patient E/M code 99211 will still be available, but its code descriptor will not include a time reference. This is used if clinical staff members perform the face-to-face visit under the supervision of the physician or other qualified healthcare professional.

99212 – 99215: will follow many of the same guidelines as the new patient codes and differ in the amount of time spent with the patient.

Code History/Exam MDM Total Minutes
99212 Medically appropriate history and/or examination Straightforward 10-19
99213 Low 20-29
99214 Moderate 30-39
99215 High 40-54

You can read more about changes to E/M codes here: https://www.aapc.com/evaluation-management/em-codes-changes-2021.aspx


REMINDER: The updates from 2020 to 2021 have been some of the most extensive in more than 25 years. Because of these extensive changes, is exceedingly important to update your coding books to prevent billing errors or incorrect payment(s); however yearly book updates are suggested.


About PGM

Physicians Group Management (PGM) is one of the fastest-growing medical billing companies in the United States.  For over 35 years, PGM has been providing medical billing and practice management services and software to physicians, healthcare facilities, and laboratories.  PGM’s current client base encompasses the full spectrum of medical specialties, including Internal Medicine, Dermatology, Plastic & Reconstructive Surgery, Pathology, EMS & Ambulatory Services, Cardiology, Nephrology, Urology, Pain Management, OB/GYN, Gastroenterology, Independent Laboratory, and many more.  PGM’s medical billing and practice management solutions include:

– A full suite of practice management and medical billing solutions each tailored to the specific needs of your practice

– CCHIT-certified electronic medical record software and services

– Streamlined, customized credentialing services for providers of all sizes

– Practice management software that provides advanced financial and practice analysis tools, specifically designed to give enhanced visibility of operations at the click of a button

Laboratory billing software that offers best-in-class systems to streamline, and manage and track, financial and administrative processes