Difference between revisions of "Billing codes (CPT) and wRVUs"
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(added advance care planning codes) |
(→Outpatient: updated with 2021 time criteria) Tag: visualeditor |
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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 | + | |99356 |
− | | Inpatient prolonged service direct contact, first hour | + | |Inpatient prolonged service direct contact, first hour |
| | | | ||
− | | 30 to 60 minutes | + | |30 to 60 minutes |
|- | |- | ||
− | | 99357 | + | |99357 |
− | | Inpatient prolonged service direct contact, additional 30 minutes | + | |Inpatient prolonged service direct contact, additional 30 minutes |
| | | | ||
| +30 minutes | | +30 minutes | ||
Line 93: | 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 | + | |10 minutes |
|- | |- | ||
− | | 99202 | + | |99202 |
− | | Office visit, new patient, level 2, straightforward medical decision making | + | |Office visit, new patient, level 2, straightforward medical decision making |
| | | | ||
− | | 20 minutes | + | |2021 and on: 15-29 minutes overall time (Before 2021: at least 20 minutes with patient) |
|- | |- | ||
− | | 99203 | + | |99203 |
− | | Office visit, new patient, level 3, low medical decision making | + | |Office visit, new patient, level 3, low medical decision making |
| | | | ||
− | | 30 minutes | + | |2021 and on: 30-44 minutes overall time (Before 2021: at least 30 minutes with patient) |
|- | |- | ||
− | | 99204 | + | |99204 |
− | | Office visit, new patient, level 4, moderate medical decision making | + | |Office visit, new patient, level 4, moderate medical decision making |
| | | | ||
− | | 45 minutes | + | |2021 and on: 45-59 minutes overall time (Before 2021: at least 45 minutes with patient) |
|- | |- | ||
− | | 99205 | + | |99205 |
− | | Office visit, new patient, level 5, high medical decision making | + | |Office visit, new patient, level 5, high medical decision making |
| | | | ||
− | | 60 minutes | + | |2021 and on: 60-74 minutes overall time (Before 2021: at least 60 minutes with patient) |
|- | |- | ||
− | | 99212 | + | |99212 |
− | | Office visit, established patient, level 2, straightforward medical decision making | + | |Office visit, established patient, level 2, straightforward medical decision making |
| | | | ||
− | | 10 minutes | + | |2021 and on: 10-19 minutes overall time (Before 2021: at least 10 minutes with patient) |
|- | |- | ||
− | | 99213 | + | |99213 |
− | | Office visit, established patient, level 3, low medical decision making | + | |Office visit, established patient, level 3, low medical decision making |
| | | | ||
− | | 15 minutes | + | |2021 and on: 20-29 minutes overall time (Before 2021: at least 15 minutes with patient) |
|- | |- | ||
− | | 99214 | + | |99214 |
− | | Office visit, established patient, level 4, moderate medical decision making | + | |Office visit, established patient, level 4, moderate medical decision making |
| | | | ||
− | | 25 minutes | + | |2021 and on: 30-39 minutes overall time (Before 2021: at least 25 minutes with patient) |
|- | |- | ||
− | | 99215 | + | |99215 |
− | | Office visit, established patient, level 5, high medical decision making | + | |Office visit, established patient, level 5, high medical decision making |
| | | | ||
− | | 40 minutes | + | |2021 and on: 40-54 minutes overall time (Before 2021: at least 40 minutes with patient) |
|- | |- | ||
− | | 99241 | + | |99241 |
− | | Office visit, new consult, level 1, straightforward medical decision making | + | |Office visit, new consult, level 1, straightforward medical decision making |
| | | | ||
− | | 15 minutes | + | |15 minutes |
|- | |- | ||
− | | 99242 | + | |99242 |
− | | Office visit, new consult, level 2, straightforward medical decision making | + | |Office visit, new consult, level 2, straightforward medical decision making |
| | | | ||
− | | 30 minutes | + | |30 minutes |
|- | |- | ||
− | | 99243 | + | |99243 |
− | | Office visit, new consult, level 3, low medical decision making | + | |Office visit, new consult, level 3, low medical decision making |
| | | | ||
− | | 40 minutes | + | |40 minutes |
|- | |- | ||
− | | 99244 | + | |99244 |
− | | Office visit, new consult, level 4, moderate medical decision making | + | |Office visit, new consult, level 4, moderate medical decision making |
| | | | ||
− | | 60 minutes | + | |60 minutes |
|- | |- | ||
− | | 99245 | + | |99245 |
− | | Office visit, new consult, level 5, high medical decision making | + | |Office visit, new consult, level 5, high medical decision making |
| | | | ||
− | | 80 minutes | + | |80 minutes |
|- | |- | ||
− | | | + | |99417 |
− | | Outpatient prolonged service | + | |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) |
| | | | ||
− | | 30 to 60 minutes | + | |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 | | +99355 | ||
− | | Outpatient prolonged service direct contact, additional 30 minutes | + | |Outpatient prolonged service direct contact, additional 30 minutes |
| | | | ||
| +30 minutes | | +30 minutes | ||
|- | |- | ||
− | | 99358 | + | |99358 |
− | | Outpatient non face-to-face prolonged service before and/or after direct patient care, first hour | + | |Outpatient non face-to-face prolonged service before and/or after direct patient care, first hour |
| | | | ||
− | | 31 to 60 minutes | + | |31 to 60 minutes |
|- | |- | ||
| +99359 | | +99359 | ||
− | | Outpatient non face-to-face prolonged service before and/or after direct patient care, each additional 30 minutes | + | |Outpatient non face-to-face prolonged service before and/or after direct patient care, each additional 30 minutes |
| | | | ||
| +30 minutes | | +30 minutes | ||
Line 193: | 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 | + | |99217 |
− | | Observation discharge day management | + | |Observation discharge day management |
| | | | ||
| | | | ||
|- | |- | ||
− | | 99234 | + | |99234 |
− | | Observation/inpatient care, admit & discharge on same date, level 1, low medical decision making | + | |Observation/inpatient care, admit & discharge on same date, level 1, low medical decision making |
+ | | | ||
| | | | ||
− | |||
|- | |- | ||
− | | 99235 | + | |99235 |
− | | Observation/inpatient care, admit & discharge on same date, level 2, moderate medical decision making | + | |Observation/inpatient care, admit & discharge on same date, level 2, moderate medical decision making |
+ | | | ||
| | | | ||
− | |||
|- | |- | ||
− | | 99236 | + | |99236 |
− | | Observation/inpatient care, admit & discharge on same date, level 3, high medical decision making | + | |Observation/inpatient care, admit & discharge on same date, level 3, high medical decision making |
+ | | | ||
| | | | ||
− | |||
|- | |- | ||
|} | |} | ||
Line 252: | Line 257: | ||
!Time billing | !Time billing | ||
|- | |- | ||
− | | 99497 | + | |99497 |
− | | Advance care planning, face-fo-face time, first 30 minutes | + | |Advance care planning, face-fo-face time, first 30 minutes |
| | | | ||
− | | 16 to 30 minutes | + | |16 to 30 minutes |
|- | |- | ||
| +99498 | | +99498 | ||
− | | Advance care planning, face-fo-face time, additional 30 minutes | + | |Advance care planning, face-fo-face time, additional 30 minutes |
| | | | ||
| +30 minutes | | +30 minutes | ||
Line 271: | Line 276: | ||
!Time billing | !Time billing | ||
|- | |- | ||
− | | 99304 | + | |99304 |
− | | Initial nursing facility care, low complexity | + | |Initial nursing facility care, low complexity |
| | | | ||
− | | 25 minutes | + | |25 minutes |
|- | |- | ||
− | | 99305 | + | |99305 |
− | | Initial nursing facility care, moderate complexity | + | |Initial nursing facility care, moderate complexity |
| | | | ||
− | | 35 minutes | + | |35 minutes |
|- | |- | ||
− | | 99306 | + | |99306 |
− | | Initial nursing facility care, high complexity | + | |Initial nursing facility care, high complexity |
| | | | ||
− | | 45 minutes | + | |45 minutes |
|- | |- | ||
− | | 99307 | + | |99307 |
− | | Subsequent nursing facility care, straightforward | + | |Subsequent nursing facility care, straightforward |
| | | | ||
− | | 10 minutes | + | |10 minutes |
|- | |- | ||
− | | 99308 | + | |99308 |
− | | Subsequent nursing facility care, low complexity | + | |Subsequent nursing facility care, low complexity |
| | | | ||
− | | 15 minutes | + | |15 minutes |
|- | |- | ||
− | | 99309 | + | |99309 |
− | | Subsequent nursing facility care, moderate complexity | + | |Subsequent nursing facility care, moderate complexity |
| | | | ||
− | | 25 minutes | + | |25 minutes |
|- | |- | ||
− | | 99310 | + | |99310 |
− | | Subsequent nursing facility care, high complexity | + | |Subsequent nursing facility care, high complexity |
| | | | ||
− | | 35 minutes | + | |35 minutes |
|- | |- | ||
|} | |} | ||
Line 315: | Line 320: | ||
!wRVU | !wRVU | ||
|- | |- | ||
− | | 38220 | + | |38220 |
− | | Bone marrow aspiration | + | |Bone marrow aspiration |
| | | | ||
|- | |- | ||
− | | 38221 | + | |38221 |
− | | Bone marrow biopsy | + | |Bone marrow biopsy |
− | | | + | | |
|- | |- | ||
− | | 96450 | + | |96450 |
− | | Chemotherapy injection into CNS (including intrathecal), requiring and including spinal puncture | + | |Chemotherapy injection into CNS (including intrathecal), requiring and including spinal puncture |
− | | | + | | |
|- | |- | ||
− | | 96542 | + | |96542 |
− | | Chemotherapy injection, administration into subarachnoid or intraventricular space via subcutaneous reservoir, single or multiple agents | + | |Chemotherapy injection, administration into subarachnoid or intraventricular space via subcutaneous reservoir, single or multiple agents |
− | | | + | | |
|- | |- | ||
− | | 62270 | + | |62270 |
− | | Lumbar puncture, diagnostic spinal tap | + | |Lumbar puncture, diagnostic spinal tap |
− | | | + | | |
|- | |- | ||
− | | 62272 | + | |62272 |
− | | Lumbar puncture, therapeutic spinal tap for drainage of cerebrospinal fluid (CSF) by needle or catheter | + | |Lumbar puncture, therapeutic spinal tap for drainage of cerebrospinal fluid (CSF) by needle or catheter |
− | | | + | | |
|- | |- | ||
|} | |} | ||
==References== | ==References== | ||
− | <references/> | + | <references /> |
[[Category:General reference pages]] | [[Category:General reference pages]] |
Revision as of 00:12, 3 June 2021
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 |