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 | 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 | 20 minutes | |
99203 | Office visit, new patient, level 3, low medical decision making | 30 minutes | |
99204 | Office visit, new patient, level 4, moderate medical decision making | 45 minutes | |
99205 | Office visit, new patient, level 5, high medical decision making | 60 minutes | |
99212 | Office visit, established patient, level 2, straightforward medical decision making | 10 minutes | |
99213 | Office visit, established patient, level 3, low medical decision making | 15 minutes | |
99214 | Office visit, established patient, level 4, moderate medical decision making | 25 minutes | |
99215 | Office visit, established patient, level 5, high medical decision making | 40 minutes | |
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 |
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 |
Procedures
E/M billing code | Service | wRVU |
---|---|---|
38220 | Bone marrow aspiration | |
38221 | Bone marrow biopsy |