Table of Contents

Outline

Office or Other Outpatient Services

MDM Levels

Inpatient Floor or Consult Billing

Initial Encounter

Code Requirements, MDM Requirements, Time
99221 straightforward or low level MDM if using time, must be >= 40 minutes
99222 moderate level MDM if using time, must be >= 55 minutes
99223 High level MDM if using time, must be >= 75 minutes

Subsequent Encounter

Code Requirements, MDM Requirements, Time
99231 straightforward or low level MDM if using time, must be >= 25 minutes
99232 moderate level MDM if using time, must be >= 35 minutes
99233 High level MDM if using time, must be >= 50 minutes

Definitions

New Patient

A new patient is one who has not received any professional services from the physician or other qualified health care professional or another physician or other qualified health care professional

  1. of the exact same specialty and subspecialty who
  2. belongs to the same group practice
  3. within the past three years.

Tables

Code Type CPET Code
Hospital Inpatient and Observation Care Services E/M codes 99221-99223, 99231-99239
Consultations E/M codes 99242-99245, 99252-99255