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Within sixish months of the CMS announcement, the American Medical Association (AMA) announced that it would be revising the office/outpatient E&M code set 99201-99215, effective Jan. 1, 2021. AMA stepping to the plate created calm for many, as discussions regarding whether commercial carriers, advantage plans, and state Medicaid programs would agree to follow the CMS recommendations were producing angst. The MPFS 2020 final rule addressed the substantial changes that the AMA announced for E/M office/outpatient codes in 2021, stating that Medicare would adopt the MDM guidelines revised by CPT ® and would allow the use of time or MDM for office/outpatient E/M code selection. The final rule also stated that Medicare would monitor claims to watch for shifts in visit levels billed, including whether certain specialties are affected more than others. Within sixish months of the CMS announcement, the American Medical Association (AMA) announced that it would be revising the office/outpatient E&M code set 99201-99215, effective Jan. 1, 2021. AMA stepping to the plate created calm for many, as discussions regarding whether commercial carriers, advantage plans, and state Medicaid programs would agree to follow the CMS recommendations were producing angst. Read the AMA’s summary of 2021 Medicare Physician Payment Schedule and Quality Payment Program for an in-depth look at the major elements of CMS’ final rule.

Time-Based Coding Guidelines. According to the AMA, the 2021 E/M code changes apply to the new coding elements when a qualified healthcare professional performs the following services: Once the revisions became effective on Jan. 1, 2021, the AMA received a lot of feedback on areas causing confusion. In response, the CPT Editorial Panel’s executive committee accepted technical corrections to the E/M guidelines to provide clarifications in a number of key areas. These revisions were posted March 9, 2021 and are effective as All other E/M services that are defined by the three key components will continue to use the 1995 and/or 1997 Documentation Guidelines, not just in 2020, but in 2021. The AMA is continuing to work on changes to other codes, but don’t expect them before 2023. The 2021 Medicare physician payment schedule finalized an AMA-developed approach for less burdensome coding and documenting of office and outpatient evaluation and management (E/M) services.

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The changes below relate only to new and established patient visits in 2021, codes 99202—99215. These changes are in the 2021 CPT book. Code 99201 is deleted.
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AMA stepping to the plate created calm for many, as discussions regarding whether commercial carriers, advantage plans, and state Medicaid programs would agree to follow the CMS recommendations were producing angst.

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E/M Office Visit Compendium 2021 - American Medical - Adlibris

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