Difference between revisions of "Billing codes (CPT) and wRVUs"
Jump to navigation
Jump to search
(Created page with "This information is obtained from the Medicare Physician Fee Schedule (MPFS) and third party sources<ref>[http://www.cms.gov/apps/physician-fee-schedule/overview.aspx Medicare...") |
Warner-admin (talk | contribs) m (Text replacement - " " to " ") |
||
(8 intermediate revisions by 2 users not shown) | |||
Line 1: | Line 1: | ||
− | This information is obtained from the Medicare Physician Fee Schedule (MPFS) and third party sources<ref>[http://www.cms.gov/apps/physician-fee-schedule/overview.aspx Medicare Physician Fee Schedule (MPFS)]</ref><ref>[http://www.medicalpmrg.com/resources/understanding-your-reimbursement-and-fee-schedule.html Happy Hospitalist - Work (wRVU) and Total (tRVU) List For Hospitalist E/M CPT® Codes]</ref> for work Relative Value Units (wRVUs) for CPT® (Current Procedural Terminology) E/M (evaluation and management) billing codes. | + | This information is obtained from the Medicare Physician Fee Schedule (MPFS) and third party sources<ref>[http://www.cms.gov/apps/physician-fee-schedule/overview.aspx Medicare Physician Fee Schedule (MPFS)]</ref><ref>[http://www.medicalpmrg.com/resources/understanding-your-reimbursement-and-fee-schedule.html Happy Hospitalist - Work (wRVU) and Total (tRVU) List For Hospitalist E/M CPT® Codes]</ref> 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== | ==Inpatient== | ||
Line 8: | Line 8: | ||
!Time billing | !Time billing | ||
|- | |- | ||
− | | 99221 | + | |99221 |
− | | Initial hospital level care, level 1, straightforward/low medical decision making | + | |Initial hospital level care, level 1, straightforward/low medical decision making |
| | | | ||
− | | 30 minutes | + | |30 minutes |
|- | |- | ||
− | | 99222 | + | |99222 |
− | | Initial hospital level care, level 2, moderate medical decision making | + | |Initial hospital level care, level 2, moderate medical decision making |
| | | | ||
− | | 50 minutes | + | |50 minutes |
|- | |- | ||
− | | 99223 | + | |99223 |
− | | Initial hospital level care, level 3, high medical decision making | + | |Initial hospital level care, level 3, high medical decision making |
| | | | ||
− | | 70 minutes | + | |70 minutes |
|- | |- | ||
− | | 99231 | + | |99231 |
− | | Subsequent hospital care, level 1, straightforward/low medical decision making | + | |Subsequent hospital care, level 1, straightforward/low medical decision making |
| | | | ||
− | | 15 minutes | + | |15 minutes |
|- | |- | ||
− | | 99232 | + | |99232 |
− | | Subsequent hospital care, level 2, moderate medical decision making | + | |Subsequent hospital care, level 2, moderate medical decision making |
| | | | ||
− | | 25 minutes | + | |25 minutes |
|- | |- | ||
− | | 99233 | + | |99233 |
− | | Subsequent hospital care, level 3, high medical decision making | + | |Subsequent hospital care, level 3, high medical decision making |
| | | | ||
− | | 35 minutes | + | |35 minutes |
|- | |- | ||
− | | 99251 | + | |99251 |
− | | Inpatient initial consultation, level 1, straightforward medical decision making | + | |Inpatient initial consultation, level 1, straightforward medical decision making |
| | | | ||
− | | 20 minutes | + | |20 minutes |
|- | |- | ||
− | | 99252 | + | |99252 |
− | | Inpatient initial consultation, level 2, straightforward medical decision making | + | |Inpatient initial consultation, level 2, straightforward medical decision making |
| | | | ||
− | | 40 minutes | + | |40 minutes |
|- | |- | ||
− | | 99253 | + | |99253 |
− | | Inpatient initial consultation, level 3, low medical decision making | + | |Inpatient initial consultation, level 3, low medical decision making |
| | | | ||
− | | 55 minutes | + | |55 minutes |
|- | |- | ||
− | | 99254 | + | |99254 |
− | | Inpatient initial consultation, level 4, moderate medical decision making | + | |Inpatient initial consultation, level 4, moderate medical decision making |
| | | | ||
− | | 80 minutes | + | |80 minutes |
|- | |- | ||
− | | 99255 | + | |99255 |
− | | Inpatient initial consultation, level 5, high medical decision making | + | |Inpatient initial consultation, level 5, high medical decision making |
| | | | ||
− | | 110 minutes | + | |110 minutes |
|- | |- | ||
− | | 99238 | + | |99238 |
− | | Inpatient discharge day management, up to 30 minutes | + | |Inpatient discharge day management, up to 30 minutes |
| | | | ||
− | | ≤30 minutes | + | |≤30 minutes |
|- | |- | ||
− | | 99239 | + | |99239 |
− | | Inpatient discharge day management, over 30 minutes | + | |Inpatient discharge day management, over 30 minutes |
| | | | ||
− | | >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 | ||
|- | |- | ||
|} | |} | ||
Line 83: | Line 93: | ||
!Time billing | !Time billing | ||
|- | |- | ||
− | | 99201 | + | |99201 |
− | | Office visit, new patient, level 1, straightforward medical decision making | + | |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 | + | |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 | + | |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 | + | |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, | + | |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 | + | |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 | + | |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 | + | |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, | + | |Office visit, new consult, level 1, straightforward medical decision making |
| | | | ||
− | | | + | |15 minutes |
|- | |- | ||
− | | | + | |99242 |
− | | Office visit, new consult, level | + | |Office visit, new consult, level 2, straightforward medical decision making |
| | | | ||
− | | | + | |30 minutes |
|- | |- | ||
− | | | + | |99243 |
− | | Office visit, new consult, level | + | |Office visit, new consult, level 3, low medical decision making |
| | | | ||
− | | | + | |40 minutes |
|- | |- | ||
− | | | + | |99244 |
− | | Office visit, new consult, level | + | |Office visit, new consult, level 4, moderate medical decision making |
| | | | ||
− | | | + | |60 minutes |
|- | |- | ||
− | | | + | |99245 |
− | | Office visit, new consult, level | + | |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 | ||
|- | |- | ||
|} | |} | ||
Line 163: | Line 198: | ||
!Time billing | !Time billing | ||
|- | |- | ||
− | | 99218 | + | |99218 |
− | | Initial observation care, level 1, straightforward/low medical decision making | + | |Initial observation care, level 1, straightforward/low medical decision making |
+ | | | ||
| | | | ||
− | |||
|- | |- | ||
− | | 99219 | + | |99219 |
− | | Initial observation care, level 2, moderate medical decision making | + | |Initial observation care, level 2, moderate medical decision making |
+ | | | ||
| | | | ||
− | |||
|- | |- | ||
− | | 99220 | + | |99220 |
− | | Initial observation care, level 3, high medical decision making | + | |Initial observation care, level 3, high medical decision making |
+ | | | ||
| | | | ||
− | |||
|- | |- | ||
− | | 99224 | + | |99224 |
− | | Subsequent observation care, level 1, straightforward/low medical decision making | + | |Subsequent observation care, level 1, straightforward/low medical decision making |
+ | | | ||
| | | | ||
− | |||
|- | |- | ||
− | | 99225 | + | |99225 |
− | | Subsequent observation care, level 2, moderate medical decision making | + | |Subsequent observation care, level 2, moderate medical decision making |
+ | | | ||
| | | | ||
− | |||
|- | |- | ||
− | | 99226 | + | |99226 |
− | | Subsequent observation care, level 3, high medical decision making | + | |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 discharge | + | |Observation/inpatient care, admit & discharge on same date, level 3, high medical decision making |
| | | | ||
| | | | ||
+ | |- | ||
+ | |} | ||
+ | |||
+ | ==Advance care planning (ACP)== | ||
+ | {| class="wikitable sortable" border="1" style="text-align:left;" | ||
+ | !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)== | ||
+ | {| class="wikitable sortable" border="1" style="text-align:left;" | ||
+ | !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 | ||
|- | |- | ||
|} | |} | ||
Line 207: | Line 320: | ||
!wRVU | !wRVU | ||
|- | |- | ||
− | | 38220 | + | |38220 |
− | | Bone marrow aspiration | + | |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 | ||
+ | | | ||
|- | |- | ||
|} | |} | ||
==References== | ==References== | ||
− | <references/> | + | <references /> |
+ | |||
+ | [[Category:General reference pages]] |
Latest revision as of 02:06, 1 June 2023
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 |