CPT Codes Overview E M Office Revisions & MDM Levels Guide

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Table 2 – CPT E/M Office Revisions
Revisions effective January 1, 2021:
Level of Medical Decision Making (MDM)
Note: this content will not be included in the CPT 2020 code set release


Elements of Medical Decision Making
Level of MDM Amount and/or Complexity of Data to
Code (Based on 2 out of 3 Number and Complexity
Elements of MDM) be Reviewed and Analyzed
of Problems Addressed *Each unique test, order, or document contributes to the combination of 2 or combination of 3 in
99211 N/A N/A N/A

99202 Straightforward Minimal Minimal or none
99212  1 self-limited or minor problem

99203 Low Low Limited
99213  2 or more self-limited or minor problems; (Must meet the requirements of at least 1 of the 2 categories)
or Category 1: Tests and documents
 1 stable chronic illness;  Any combination of 2 from the following:
or  Review of prior external note(s) from each unique source*;
 1 acute, uncomplicated illness or injury  review of the result(s) of each unique test*;
 ordering of each unique test*
or
Category 2: Assessment requiring an independent historian(s)
(For the categories of independent interpretation of tests and discussion of management or test int
moderate or high)

99204 Moderate Moderate Moderate
99214  1 or more chronic illnesses with exacerbation, (Must meet the requirements of at least 1 out of 3 categories)
progression, or side effects of treatment; Category 1: Tests, documents, or independent historian(s)
or  Any combination of 3 from the following:
 2 or more stable chronic illnesses;  Review of prior external note(s) from each unique source*;
or  Review of the result(s) of each unique test*;
 1 undiagnosed new problem with uncertain prognosis;  Ordering of each unique test*;
or  Assessment requiring an independent historian(s)
 1 acute illness with systemic symptoms; or
or Category 2: Independent interpretation of tests
 1 acute complicated injury  Independent interpretation of a test performed by another physician/other qualified health ca
separately reported);
or
Category 3: Discussion of management or test interpretation
 Discussion of management or test interpretation with external physician/other qualified health
professional\appropriate source (not separately reported)

99205 High High Extensive