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 |