Coding Ahead

List With Office Visit CPT Codes (New & Established Patients)

The CPT codes for office visits can be found in the CPT manual; under range CPT 99202 until 99205 for office visits of new patients . For office visits of established patients, you can use range 99211 to CPT code 99215. We also included CPT 99070 in case you need to bill extra supplies/materials for office visits and CPT code 99072 if extra staff and supplies were needed during a Public Health Emergency.

CPT Code 99070

Long description of CPT 99070 : Supplies and materials [except spectacles] provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided].

Short description: Extra supplies/materials for office visit.

CPT Code 99072

Long description of CPT 99072 : Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service[s], when performed during a Public Health Emergency, as defined by law, due to respiratory-transmitted infectious disease.

Short description: Extra supplies and staff time for office visits during Public Health Emergency.

CPT Code 99202

Long description of CPT 99202 : Office or other outpatient visit for the evaluation and management of a new patient , which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.

Short description: 15-29 minute office visit for new patient evaluation and management.

CPT Code 99203

Long description of CPT 99203 : Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.

Short description: 30-44 minute office visit for new patient evaluation and management.

CPT Code 99204

Long description of CPT 99204 : Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spend on the date of the encounter.

Short description: 45-59 minute office visit for new patient evaluation and management.

CPT Code 99205

Long description of CPT 99205 : Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code+ selection, 60-74 minutes of total time is spent on the date of the encounter.

Short description: 60-74 minute office visit for new patient evaluation and management.

CPT Code 99211

Long description of CPT 99211 : Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional

Short description: Short office visit for established patient management.

CPT Code 99212

Long description of CPT Code 99212 : Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time spent on the date of the encounter.

Short description: 10-19 minute office visit for established patient management.

CPT Code 99213

Long description of CPT 99213 : Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.

Short description: 20-29 minute office visit for established patient management.

CPT Code 99214

Long description of CPT 99214 : Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision-making. When using time for code selection, 30-39 minutes of total time is spend on the date of the encounter.

Short description: 30-39 minutes office visit for established patient management.

CPT Code 99215

Long description of CPT 99215 : Office or other outpatient visit for the evaluation and management of an established patient, which requires medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.

Short description: 40-54 minutes office visit for established patient management .

https://www.aapc.com/codes/cpt-codes-range/99211-99215/

https://www.aapc.com/codes/cpt-codes-range/99202-99205/

https://www.aapc.com/codes/cpt-codes/99070

https://www.aapc.com/codes/cpt-codes/99072

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Coding for E/M home visits changed this year. Here’s what you need to know

CPT has revised codes for at-home evaluation and management (E/M) services as of Jan. 1, 2023. Services to patients in a private residence (e.g., house or apartment) or temporary lodgings (e.g., hotel or shelter) are now combined with services in facilities where only minimal health care is provided (e.g., independent or assisted living) in these code families:

Home or residence E/M services, new patient

• 99341, straightforward medical decision making (MDM) or at least 15 minutes total time,

• 99342, low level MDM or at least 30 minutes total time,

• 99344 (code 99343 has been deleted), moderate level MDM or at least 60 minutes total time, 

• 99345, high level MDM or at least 75 minutes total time.

Home or residence services, established patient   

• 99347, straightforward MDM or at least 20 minutes total time,

• 99348, low level MDM or at least 30 minutes total time,

• 99349, moderate level MDM or at least 40 minutes total time,

• 99350, high level MDM or at least 60 minutes total time. 

Select these codes based on either your level of medical decision making or total time on the date of the encounter , similar to selecting codes for office visits . The E/M codes specific to domiciliary, rest home (e.g., boarding home), or custodial care (99324-99238, 99334-99337, 99339, and 99340) have been deleted, and the above codes should also be used in those settings.

When total time on the date of the encounter exceeds the threshold for code 99345 or 99350 by at least 15 minutes, you can add code 99417 to report prolonged services. The exception to this is for patients with Medicare. For those patients, report prolonged home or residence services to Medicare with code G0318 in addition to 99345 (requires total time ≥140 minutes) or 99350 (requires total time ≥110 minutes). Code G0318 is not limited to time on the date of the encounter, but includes any work within three days prior to the service or within seven days after.

Services provided in facilities where significant medical or psychiatric care is available (e.g., nursing facility, intermediate care facility for persons with intellectual disabilities, or psychiatric residential treatment facility) are reported with codes 99304-99310 .

— Cindy Hughes, CPC, CFPC

Posted on Jan. 19, 2023

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Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use .

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IMAGES

  1. Common OT Outpatient CPT codes! PDF download available on our website

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  1. Office/Outpatient E/M Codes

    More details about these office/outpatient E/M changes can be found at CPT® Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99XXX) Code and Guideline Changes. Download the Office E/M Coding Changes Guide (PDF) 2021 E/M Office/Outpatient Visit CPT Codes.

  2. Outpatient E/M Coding Simplified

    The workgroup approved significant revisions to the outpatient office visit E/M codes. Code 99201 was deleted. The history and/or physical examination and the counting of bullets were eliminated ...

  3. What Is Outpatient Facility Coding and Reimbursement?

    When a Medicare patient is evaluated in the outpatient hospital clinic, the clinic visit is coded using HCPCS Level II code G0463 Hospital outpatient clinic visits for assessment and management of a patient instead of the standard E/M CPT ® code (99202-99215) a pro-fee coder uses when reporting professional fee services.

  4. E/M coding for outpatient services

    The codes apply to services that a wide range of primary care and specialty providers perform regularly. Some of the most commonly reported E/M codes are 99201-99215, which represent office or other outpatient visits. In 2020, the E/M codes for office and outpatient visits include patient history, clinical examination, and medical decision ...

  5. PDF Simplified Outpatient Documentation and Coding

    amount of time spent providing care for a patient on the day of the visit (including before and after the visit, not just face-to-face time)—see Table 1. Table 1. Overview of CPT® E/M Coding CPT® New 99202 Established 99212 New 99203 Established 99213 New 99204 Established 99214 New 99205 Established 99215

  6. A Step-by-Step Time-Saving Approach to Coding Office Visits

    Step 1: Total time. Think time first. If your total time spent on a visit appropriately credits you for level 3, 4, or 5 work, then document that time, code the visit, and be done with it. But if ...

  7. PDF Office/Outpatient Evaluation and Management Services Reference ...

    CPT® code 99417 is used to report additional time beyond the time periods required for office/outpatient E/M visits. Additional time includes face-to-face and non-face-to-face activities. Code 99417 may only be used when total time has been used to select the appropriate E/M visit and the highest E/M level has been achieved (i.e., 99205 or 99215).

  8. CPT® code 99212: Established patient office visit, 10-19 minutes

    CPT® code 99212: Established patient office or other outpatient visit, 10-19 minutes. As the authority on the CPT® code set, the AMA is providing the top-searched codes to help remove obstacles and burdens that interfere with patient care. These codes, among the rest of the CPT code set, are clinically valid and updated on a regular basis to ...

  9. PDF Introduction to 2021 Office and Other Outpatient E/M Codes

    at the visit • This includes the possible management options selected and those considered, but not selected, after shared medical decision making. • CPT examples: • A psychiatric patient with a sufficient degree of support in the outpatient setting • The decision to not hospitalize a patient with advanced dementia with an acute ...

  10. The 2021 Office Visit Coding Changes: Putting the Pieces Together

    The American Medical Association (AMA) has established new coding and documentation guidelines for office visit/outpatient evaluation and management (E/M) services, effective Jan. 1, 2021.

  11. PDF Coding for hospital admission, consultations, and emergency department

    office/outpatient visit new Cpt office/outpatient visit established Cpt office/outpatient consultation 99201 1.29 99211 0.60 99241 1.37 99202 2.19 99212 1.29 99242 2.58 99203 3.17 99213 2.13 99243 3.52 99204 4.84 99214 3.13 99244 5.20 99205 5.99 99215 4.20 99245 6.36 tABL 1.e 2013 totAL oFFiCe/outPAtieNt NeW, estABLisHeD, AND CoNsuLtAtioN ...

  12. List of CPT/HCPCS Codes

    The applicability of the exception for preventive screening tests and vaccines to CPT code 90739 is prospective only and effective on the date indicated on the UPDATED list of codes. In considering this comment, we also identified two CPT codes (90653 and 90658, both flu vaccines) that were inadvertently left off of the list of codes to which ...

  13. Office or Other Outpatient Services CPT ® Code range 99202- 99215

    The Current Procedural Terminology (CPT) code range for Office or Other Outpatient Services 99202-99215 is a medical code set maintained by the American Medical Association. Subscribe to Codify by AAPC and get the code details in a flash.

  14. PDF How to Use the Office & Outpatient Evaluation and Management Visit

    types of factors, the E/M visit is more complex. In this example, you may bill G2211. G2211 and Modifier 25 . G2211 may not be reported without reporting an associated O/O E/M visit. G2211 isn't payable when the associated O/O E/M visit is reported with modifier 25. You can add modifier 25 to an E/M CPT code to show the E/M service is ...

  15. New Billing Rules for Outpatient Office Visit Codes

    In 2018, CMS described a plan for the Physician Fee Schedule for 2019 to collapse outpatient E/M visit levels 2 to 5 (99202-99205 and 99212-99215), with the stated intent of simplifying documentation and reducing clerical burden. ... Deletion of CPT code 99201 and adoption of the revised CPT descriptors for codes 99202 to 99215, including ...

  16. List With Office Visit CPT Codes (New & Established Patients)

    Short description: 15-29 minute office visit for new patient evaluation and management. CPT Code 99203. Long description of CPT 99203: Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is ...

  17. Tips for using total time to code E/M office visits in 2021

    99205. 60-74. 99215. 40-54. All times in minutes. For longer visits there is a prolonged visit code, 99417, that should be reported with 99205/99215 for every 15 minutes that total time exceeds ...

  18. PDF Clinical Examples 2021 Office and Other Outpatient E/M Codes

    outpatient examples • Not enough specialties participated • CPT decided to hold off on example revisions for the new code definitions • For now, examples related to these code have been deleted • Nonetheless, AACAP and APA collaborated on submitting revised examples (now on hold) • These are most of the examples cited in this webinar

  19. CPT® Code

    New Patient CPT. ®. Code range 99202- 99205. The Current Procedural Terminology (CPT) code range for Office or Other Outpatient Services 99202-99205 is a medical code set maintained by the American Medical Association.

  20. CPT® code 99204: New patient office visit, 45-59 minutes

    CPT® code 99204: New patient office or other outpatient visit, 45-59 minutes. As the authority on the CPT® code set, the AMA is providing the top-searched codes to help remove obstacles and burdens that interfere with patient care. These codes, among the rest of the CPT code set, are clinically valid and updated on a regular basis to ...

  21. Established Patient CPT ® Code range 99211- 99215

    The Current Procedural Terminology (CPT) code range for Office or Other Outpatient Services 99211-99215 is a medical code set maintained by the American Medical Association. Subscribe to Codify by AAPC and get the code details in a flash.

  22. Time and Medical Decision Making Levels for Evaluation and ...

    Office or Other Outpatient Services Total time and MDM do not apply to 99211. CPT code 99211 is intended for the evaluation and management of a patient that may not require the presence of a ...

  23. Master 99211 and Code Nurse Visits Properly Every Time : Nurse Visit Coding

    Tip 1: Prove Entire E/M Visit Via Documentation. To report 99211, the clinician must perform an E/M service. In other words, it isn't a catch-all code that you can report every time a patient passes through your practice. Example: A nurse speaks to a patient on the phone and agrees to obtain a prescription refill for her.

  24. Coding for E/M home visits changed this year. Here's what you ...

    The E/M codes specific to domiciliary, rest home (e.g., boarding home), or custodial care (99324-99238, 99334-99337, 99339, and 99340) have been deleted, and the above codes should also be used in ...

  25. Joint Size Vital to Coding Arthrocentesis Shots : Injection Coding

    20610 for the arthrocentesis 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.