Billing codes (CPT) and wRVUs
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This information is obtained from the Medicare Physician Fee Schedule (MPFS) and third party sources[1][2] for work Relative Value Units (wRVUs) for CPT® (Current Procedural Terminology) E/M (evaluation and management) billing codes. Please be aware that there seems to be variability in the content publicly available. Suggestions for additional resources are welcome.
Inpatient
| E/M billing code | Service | wRVU | Time billing |
|---|---|---|---|
| 99221 | Initial hospital level care, level 1, straightforward/low medical decision making | 30 minutes | |
| 99222 | Initial hospital level care, level 2, moderate medical decision making | 50 minutes | |
| 99223 | Initial hospital level care, level 3, high medical decision making | 70 minutes | |
| 99231 | Subsequent hospital care, level 1, straightforward/low medical decision making | 15 minutes | |
| 99232 | Subsequent hospital care, level 2, moderate medical decision making | 25 minutes | |
| 99233 | Subsequent hospital care, level 3, high medical decision making | 35 minutes | |
| 99251 | Inpatient initial consultation, level 1, straightforward medical decision making | 20 minutes | |
| 99252 | Inpatient initial consultation, level 2, straightforward medical decision making | 40 minutes | |
| 99253 | Inpatient initial consultation, level 3, low medical decision making | 55 minutes | |
| 99254 | Inpatient initial consultation, level 4, moderate medical decision making | 80 minutes | |
| 99255 | Inpatient initial consultation, level 5, high medical decision making | 110 minutes | |
| 99238 | Inpatient discharge day management, up to 30 minutes | ≤30 minutes | |
| 99239 | Inpatient discharge day management, over 30 minutes | >30 minutes | |
| 99356 | Inpatient prolonged service direct contact, first hour | 30 to 60 minutes | |
| 99357 | Inpatient prolonged service direct contact, additional 30 minutes | +30 minutes |
Outpatient
| E/M billing code | Service | wRVU | Time billing |
|---|---|---|---|
| 99201 | Office visit, new patient, level 1, straightforward medical decision making | 10 minutes | |
| 99202 | Office visit, new patient, level 2, straightforward medical decision making | 2021 and on: 15-29 minutes overall time (Before 2021: at least 20 minutes with patient) | |
| 99203 | Office visit, new patient, level 3, low medical decision making | 2021 and on: 30-44 minutes overall time (Before 2021: at least 30 minutes with patient) | |
| 99204 | Office visit, new patient, level 4, moderate medical decision making | 2021 and on: 45-59 minutes overall time (Before 2021: at least 45 minutes with patient) | |
| 99205 | Office visit, new patient, level 5, high medical decision making | 2021 and on: 60-74 minutes overall time (Before 2021: at least 60 minutes with patient) | |
| 99212 | Office visit, established patient, level 2, straightforward medical decision making | 2021 and on: 10-19 minutes overall time (Before 2021: at least 10 minutes with patient) | |
| 99213 | Office visit, established patient, level 3, low medical decision making | 2021 and on: 20-29 minutes overall time (Before 2021: at least 15 minutes with patient) | |
| 99214 | Office visit, established patient, level 4, moderate medical decision making | 2021 and on: 30-39 minutes overall time (Before 2021: at least 25 minutes with patient) | |
| 99215 | Office visit, established patient, level 5, high medical decision making | 2021 and on: 40-54 minutes overall time (Before 2021: at least 40 minutes with patient) | |
| 99241 | Office visit, new consult, level 1, straightforward medical decision making | 15 minutes | |
| 99242 | Office visit, new consult, level 2, straightforward medical decision making | 30 minutes | |
| 99243 | Office visit, new consult, level 3, low medical decision making | 40 minutes | |
| 99244 | Office visit, new consult, level 4, moderate medical decision making | 60 minutes | |
| 99245 | Office visit, new consult, level 5, high medical decision making | 80 minutes | |
| 99417 | Outpatient prolonged office or other outpatient evaluation and management service(s) (beyond the total time of the primary procedure which has been selected using total time) | every (at least) 15 minutes total time beyond maximum time for outpatient new patient or established patient time-based billing | |
| 99354 | Outpatient prolonged service direct contact, first hour | 30 to 60 minutes | |
| +99355 | Outpatient prolonged service direct contact, additional 30 minutes | +30 minutes | |
| 99358 | Outpatient non face-to-face prolonged service before and/or after direct patient care, first hour | 31 to 60 minutes | |
| +99359 | Outpatient non face-to-face prolonged service before and/or after direct patient care, each additional 30 minutes | +30 minutes |
Observation
| E/M billing code | Service | wRVU | Time billing |
|---|---|---|---|
| 99218 | Initial observation care, level 1, straightforward/low medical decision making | ||
| 99219 | Initial observation care, level 2, moderate medical decision making | ||
| 99220 | Initial observation care, level 3, high medical decision making | ||
| 99224 | Subsequent observation care, level 1, straightforward/low medical decision making | ||
| 99225 | Subsequent observation care, level 2, moderate medical decision making | ||
| 99226 | Subsequent observation care, level 3, high medical decision making | ||
| 99217 | Observation discharge day management | ||
| 99234 | Observation/inpatient care, admit & discharge on same date, level 1, low medical decision making | ||
| 99235 | Observation/inpatient care, admit & discharge on same date, level 2, moderate medical decision making | ||
| 99236 | Observation/inpatient care, admit & discharge on same date, level 3, high medical decision making |
Advance care planning (ACP)
| E/M billing code | Service | wRVU | Time billing |
|---|---|---|---|
| 99497 | Advance care planning, face-fo-face time, first 30 minutes | 16 to 30 minutes | |
| +99498 | Advance care planning, face-fo-face time, additional 30 minutes | +30 minutes |
Skilled nursing facility (SNF)
| E/M billing code | Service | wRVU | Time billing |
|---|---|---|---|
| 99304 | Initial nursing facility care, low complexity | 25 minutes | |
| 99305 | Initial nursing facility care, moderate complexity | 35 minutes | |
| 99306 | Initial nursing facility care, high complexity | 45 minutes | |
| 99307 | Subsequent nursing facility care, straightforward | 10 minutes | |
| 99308 | Subsequent nursing facility care, low complexity | 15 minutes | |
| 99309 | Subsequent nursing facility care, moderate complexity | 25 minutes | |
| 99310 | Subsequent nursing facility care, high complexity | 35 minutes |
Procedures
| E/M billing code | Service | wRVU |
|---|---|---|
| 38220 | Bone marrow aspiration | |
| 38221 | Bone marrow biopsy | |
| 96450 | Chemotherapy injection into CNS (including intrathecal), requiring and including spinal puncture | |
| 96542 | Chemotherapy injection, administration into subarachnoid or intraventricular space via subcutaneous reservoir, single or multiple agents | |
| 62270 | Lumbar puncture, diagnostic spinal tap | |
| 62272 | Lumbar puncture, therapeutic spinal tap for drainage of cerebrospinal fluid (CSF) by needle or catheter |