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What's changing for E/M codes this 2021?

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By Health Prime on December, 10 2020

Get a better understanding of the upcoming E/M coding changes, so you can be ready, prevent delays in your payments and run your medical practice smoothly.


On our latest webinar, our Health Prime's Medical Coding Team Manager, Neha Bhatnagar, gave an overview of the upcoming changes in the E/M Codes and how physicians and other healthcare professionals can prepare for these changes.

From January 1st, 2021 there will be changes in the CPT (Current Procedural Terminology) codes from 99201 to 99215 only.

What are these changes?

  • History and/or Examination change

Until now, the AMA's CPT code guidelines allowed to code on basis of documentation of 3 components to determine the correct level of E/M codes: patient history; physical examination; and medical decision making (MDM).

The major changes for 2021 will be:

-The extend of history and physical examination is not an element in selection of office or other outpatient services.

-The nature and extent of the history and/or physical examination is determined by the treating physician or other qualified health care professional reporting the service.

-Office or other outpatient services include a medically appropriate history and/or examination.

  • Code set will not include new patient level 1 code 99201

  • New patient codes from 99202 to 99205 no longer require the 3 components or reference typical face-to-face time

Code selection will be based on the MDM level or total time spent on that date and each service will include a "medically appropriate history and/or examination".

  • The AMA plans to create a new prolonged services add-on code

New Prolonged Services Add-On Code infographic (2)-1

  • E/M code 99211 change

Level 1 established patient E/M code 99211 will still be available, but its code descriptor will not include a time reference.

  • E/M codes from 99212 to 99215

Established patient E/M codes from 99212 to 99215 will look similar to the New patient codes.


Let's see this example:


E_M codes from 99212 to 99215 example


  • Appropriate level of E/M services

This level will be based either on the level of the medical decision making as defined for each service or the total time for E/M services performed on the date of the encounter.

  • Time documentation

The time documentation will include face-to-face and non-face-to-face time personally spent by the physician and/or other qualified health care professional(s) on the day of the encounter.


Does not include time in activities normally performed by clinical staff.

  • Level of service

The level of service will be based on the documented medical decision making (MDM), instead of being based on time.

What's MDM?


To understand the definition better, let's see the following infographic:

MDM infographic

If you have any question about these changes or if you want to have more information, feel free to contact us at:


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