2021 CPT® Evaluation and Management (E/M) Coding Changes
Friday, January 08, 2021

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Resources for Physician Practices 

The AMA and the Centers for Medicare & Medicaid Services have completed a major overhaul of evaluation and management (E/M) office visit documentation and coding.  These landmark changes to E/M office visit coding went into effect on January 1, 2021.  This page includes links to AMA resources as well as specialty-specific resources to help you as you implement these changes in your practice. 

The revisions to the E/M office visit CPT® codes (99201-99215) code descriptors and documentation standards directly address the continuing problem of administrative burden for physicians in nearly every specialty. 

With these changes, documentation for E/M office visits will now be centered around how physicians think and take care of patients and not on mandatory standards that encouraged copy/paste and checking boxes.  Key revisions include: 

  1. Elimination of history and physical as elements for code selection.
  2. Allow physicians to choose whether their documentation is based on Medical Decision Making (MDM) or Total Time. 
  3. Modifications to the criteria for MDM. 
  4. Deletion of CPT code 99201. 
  5. Creation of a shorter prolonged services code. 

AMA Resources 

Specialty-Specific Resources: 

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