Evaluation and Management coding

Evaluation and management (E/M) services refer to visits and consultations furnished by physicians. Billing Medicare for a patient visit requires the selection of a CPT code that best represents the level of E/M service performed. For example, there are five CPT codes that may be selected to bill for office or other outpatient visits for a new patient:

99201 – Usually the presenting problem(s) are self limited or minor and the physician typically spends 10 minutes face-to-face with the patient and/or family. E/M requires the following three key components:

Problem focused history.
Problem focused examination.
Straightforward medical decision making.

99202 – Usually the presenting problem(s) are of low to moderate severity and the physician typically spends 20 minutes face-to-face with the patient and/or family. E/M requires the following three key components:

Expanded problem focused history.
Expanded problem focused examination.
Straightforward medical decision making.

99203 – Usually the presenting problem(s) are of moderate severity and the physician typically spends 30 minutes face-to-face with the patient and/or family. E/M requires the following three key components:

Detailed history.
Detailed examination.
Medical decision making of low complexity.

99204 – Usually the presenting problem(s) are of moderate to high severity and the physician typically spends 45 minutes face-to-face with the patient and/or family. E/M requires the following three key components:

Comprehensive history.
Comprehensive examination
Medical decision making of moderate complexity

99205 – Usually the presenting problem(s) are of moderate to high severity and the physician typically spends 60 minutes face-to-face with the patient and/or family. E/M requires the following three key components:

Comprehensive history.
Comprehensive examination.
Medical decision making of high complexity.

Medicare payment
Evaluation and Management Modifiers