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Table of Contents
Outline
Office or Other Outpatient Services
- Hospital Inpatient and Observation Care Services
- Consultations
- Emergency Department Services
- Nursing Facility Services
- Home or Residence 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
- of the exact same specialty and subspecialty who
- belongs to the same group practice
- 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 |
billing.txt · Last modified: by admin
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