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 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
99354 Outpatient prolonged service direct contact, first hour 30 to 60 minutes
99355 Outpatient prolonged service direct contact, 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

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

References

  1. Medicare Physician Fee Schedule (MPFS)
  2. Happy Hospitalist - Work (wRVU) and Total (tRVU) List For Hospitalist E/M CPT® Codes