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2021 Evaluation and Management Codes

Office or Other Outpatient Services

New

Based on MDM OR TIME

  • A problem focused history

  • A problem focused examination

  • Straightforward medical decision making

99201               

NO LONGER VALID 

This code has been deleted, as of January 1, 2021 

99202            15-29 minutes

  • medically appropriate history

  • A medically appropriate examination

  • Straightforward medical decision making

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  • A detailed history

  • A detailed examination

  • Medical decision making of Low Complexity

99203           30-44 minutes

  • medically appropriate history

  • A medically appropriate examination

  • Medical decision making of Low Complexity

99204            45-59 minutes

  • medically appropriate history

  • A medically appropriate examination

  • Medical decision making of Moderate Complexity

  • A comprehensive history

  • A comprehensive examination

  • Medical decision making of High Complexity

99205            60-74 minutes

  • medically appropriate history

  • A medically appropriate examination

  • Medical decision making of High Complexity

+99417 (Prolonged) 75+ minutes

  • Used in conjunction with 99205 (and 99215)

  • Must meet minimal requirements as 99205

  • Each additional 15 minutes

Established

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99211                Time N/A

  • Minimal presenting problem(s)

  • May not require presence of physician or other qualified health care professional

99212             10-19 minutes

  • medically appropriate history

  • A medically appropriate examination

  • Straightforward medical decision making

99213             20-29 minutes

  • medically appropriate history

  • A medically appropriate examination

  • Medical decision making of Low Complexity

99214            30-39 minutes

  • medically appropriate history

  • A medically appropriate examination

  • Medical decision making of Moderate Complexity

99215             40-54 minutes

  • medically appropriate history

  • A medically appropriate examination

  • Medical decision making of High Complexity

Based on MDM OR TIME

+99417 (Prolonged) 55+ minutes

  • Used in conjunction with 99215 (and 99205)

  • Must meet minimal requirements as 99215

  • Each additional 15 minutes

NOTE:

  • Effective January 1, 2021, Total time includes both face–to–face AND non–face–to–face activities on the encounter date. Examples include (but are not limited to) reviewing tests and otherwise preparing for the patient visit, performing the exam or evaluation, counseling and educating the patient or caregiver, ordering tests, communicating with other healthcare.

  • No Time listed for 99211.

  • Do not report +99417 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416

  • Do not report +99417 for any time unit less than 15 minutes

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