Beginning Jan 1, 2021, there were significant changes made to E/M (Evaluation and Management) coding. CMS (Medicare) has simplified the documentation needed to reduce the burden on providers.
A few highlights include:
- CPT 99201 (level 1, new patient) will be deleted
- Changes to E/M documentation apply to CPT 99202-99205 and 99211-99215 only.
- A new code, CPT 99417 for "addition of a 15-min prolonged service" will be added that can be used with 99205 and 99215.
- A new HCPCS code GPCX1 "visit complexity" will be created. Can be used on all levels. Reimbursement will be around $12
- H & P as elements for code selection will be eliminated.
- Providers no longer have to re-document the patient's history; only changes that have happened since their last visit.
- Per AMA, the changes to E/M code selection apply to Medicare, Medicaid, and all commercial payers.
- Commercial payers are not required to adopt the HCPCS code for visit complexity.
There is a great article from AMA listing all of the code/guideline changes in this link:
In the 5th paragraph, click on the word "description", and the pdf will present.
