CMS Announces Updated CPT codes and Instructions for E/M Office Codes for 2021
The AMA CPT Editorial Panel has recently approved revisions to the Current Procedural Terminology (CPT) Evaluation and Management (E/M) office or other outpatient services codes, which will have significant implications on coding and documentation for these vital services. The changes are scheduled to go into effect January 1, 2021. In addition, CMS has approved updated Relative Value Unit settings for the E/M code set.
The CPT changes are designed to reduce administrative burden and more accurately capture physician work involved in providing the services.
The most significant changes include:
MEDICARE PHYSICIAN FEE SCHEDULE VALUES
CMS, in the 2021 Medicare Physician Fee Schedule Final Rule, published their recommended changes in payment for the revised office E/M codes.
The table below shows current (2020 Medicare total payment) and the 2021 Medicare total payment.
|CPT Code||Descriptor||2021* Total
|Difference $||% Difference|
|99202||Office/outpatient visit, new, Level 1||$ 69.04||$ 46.56||$ 22.48||48%|
|99202||Office/outpatient visit, new, Level 2||$ 69.04||$ 77.23||$ (8.19)||-11%|
|99203||Office/outpatient visit, new, Level 3||$ 106.14||$ 109.35||$ (3.21)||-3%|
|99204||Office/outpatient visit, new, Level 4||$ 159.36||$ 167.09||$ (7.73)||-5%|
|99205||Office/outpatient visit, new, Level 5||$ 210.66||$ 211.12||$ (0.46)||0%|
|99211||Office/outpatient visit, established, Level 1||$ 22.26||$ 23.46||$ (1.20)||-5%|
|99212||Office/outpatient visit, established, Level 2||$ 54.20||$ 46.19||$ 8.01||17%|
|99213||Office/outpatient visit, established, Level 3||$ 86.78||$ 76.15||$ 10.63||14%|
|99214||Office/outpatient visit, established, Level 4||$ 122.91||$ 110.43||$ 12.48||11%|
|99215||Office/outpatient visit, established, Level 5||$ 172.27||$ 148.33||$ 23.94||16%|
|99354||Prolonged services, first 30 min||$120.97||$132.09||$ (11.12)||-9%|
|99355||Prolonged services, additional 30 min||$90.33||$100.33||$ (10.00)||-11%|
|*2021 Conversion factor=32.26|
|**2020 Conversion Factor=36.09|
These calculations are based on the announced Medicare conversion factor of 32.26, which is an 11% reduction from the current Medicare conversion factor. This is due to CMS applying budget neutrality from the increased RVUs for the office E/M codes. Medical societies, including ISASS, have strongly advocated to CMS to maintain the current conversion factor. If it is maintained at the 2020 level of 36.09, the payments for E/M procedures would see further increases.
The AMA has posted several helpful PowerPoint presentations and summary documents. Please see the following links for more information and resources from the AMA:
CMS has links and information as well, which can be accessed at the following links: