Professional
Services List
|
HCPCS/CPT
Code |
Description |
|
99421 |
ONLINE
DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES Online digital evaluation and management
service, for an established patient, for up to 7 days, cumulative time during
the 7 days; 5-10 minutes |
|
99422 |
ONLINE
DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES Online digital evaluation and
management service, for an established patient, for up to 7 days, cumulative
time during the 7 days; 11-20 minutes |
|
99423 |
ONLINE
DIGITAL E/M SVC EST PT <7 D 21+ MINUTES Online digital evaluation and
management service, for an established patient, for up to 7 days, cumulative
time during the 7 days; 21 or more minutes |
|
99441 |
PHYS/QHP
TELEPHONE EVALUATION 5-10 MIN.
Telephone evaluation and management service by a physician or other
qualified health care professional who may report evaluation and management
services provided to an established patient, parent, or guardian not
originating from a related E/M service provided within the previous 7 days
nor leading to an E/M service or procedure within the next 24 hours or
soonest available appointment; 5-10 minutes of
medical discussion |
|
99442 |
PHYS/QHP
TELEPHONE EVALUATION 11-20 MIN . Telephone
evaluation and management service by a physician or other qualified health
care professional who may report evaluation and management services provided
to an established patient, parent, or guardian not originating from a related
E/M service provided within the previous 7 days nor leading to an E/M service
or procedure within the next 24 hours or soonest available appointment;
11-20 minutes of medical discussion |
|
99443 |
PHYS/QHP
TELEPHONE EVALUATION 21-30 MIN. Telephone evaluation and management service
by a physician or other qualified health care professional who may report
evaluation and management services provided to an established patient,
parent, or guardian not originating from a related E/M service provided
within the previous 7 days nor leading to an E/M service or procedure within
the next 24 hours or soonest available appointment;
21-30 minutes of medical discussion |
|
99446 |
NTRPROF
PHONE/NTRNET/EHR ASSMT&MGMT 5-10 MIN
Interprofessional telephone/Internet/electronic health record
assessment and management service provided by a consultative physician,
including a verbal and written report to the patient's treating/requesting
physician or other qualified health care professional; 5-10 minutes of
medical consultative discussion and review |
|
99447 |
NTRPROF
PHONE/NTRNET/EHR ASSMT&MGMT 11-20 MIN
Interprofessional telephone/Internet/electronic health record
assessment and management service provided by a consultative physician,
including a verbal and written report to the patient's treating/requesting
physician or other qualified health care professional; 11-20 minutes of
medical consultative discussion and review |
|
99448 |
NTRPROF
PHONE/NTRNET/EHR ASSMT&MGMT 21-30 MIN
Interprofessional telephone/Internet/electronic health record
assessment and management service provided by a consultative physician,
including a verbal and written report to the patient's treating/requesting
physician or other qualified health care professional; 21-30 minutes of
medical consultative discussion and review |
|
99449 |
NTRPROF
PHONE/NTRNET/EHR ASSMT&MGMT 31/> MIN
Interprofessional telephone/Internet/electronic health record
assessment and management service provided by a consultative physician,
including a verbal and written report to the patient's treating/requesting
physician or other qualified health care professional; 31 minutes or more of
medical consultative discussion and review |
|
99450 |
BASIC LIFE
AND/OR DISABILITY EXAMINATION
Basic life and/or disability examination that includes:
Measurement of height, weight, and blood pressure; Completion of a medical
history following a life insurance pro forma; Collection of blood sample
and/or urinalysis complying with "chain of custody" protocols; and
Completion of necessary documentation/certificates. |
|
99451 |
NTRPROF
PHONE/NTRNET/EHR ASSMT&MGMT 5/> MIN
Interprofessional telephone/Internet/electronic health record assessment
and management service provided by a consultative physician, including a
written report to the patient's treating/requesting physician or other
qualified health care professional, 5 minutes or more of medical consultative
time |
|
99452 |
NTRPROF
PHONE/NTRNET/EHR REFERRAL SVC 30 MIN
Interprofessional telephone/Internet/electronic health record referral
service(s) provided by a treating/requesting physician or other qualified
health care professional, 30 minutes |
|
99453 |
REM MNTR
PHYSIOL PARAM 1ST SET UP PT EDUCAJ EQP Remote monitoring of physiologic
parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow
rate), initial; set-up and patient education on use of equipment |
|
99454 |
REM MNTR
PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D
Remote monitoring of physiologic parameter(s) (eg, weight, blood
pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply
with daily recording(s) or programmed alert(s) transmission, each 30 days |
|
99455 |
WORK
RELATED/MED DBLT XM TREATING PHYS
Work related or medical disability examination by the treating
physician that includes: Completion of a medical
history commensurate with the patient's condition; Performance of an
examination commensurate with the patient's condition; Formulation of a
diagnosis, assessment of capabilities and stability, and calculation of
impairment; Development of future medical treatment plan; and Completion of
necessary documentation/certificates and report. |
|
99456 |
WORK
RELATED/MED DBLT XM OTH/THN TREATING PHYS
Work related or medical disability examination by other than the
treating physician that includes: Completion of a medical history
commensurate with the patient's condition; Performance of an examination
commensurate with the patient's condition; Formulation of a diagnosis,
assessment of capabilities and stability, and calculation of impairment;
Development of future medical treatment plan; and Completion of necessary documentation/certificates
and report. |
|
99460 |
1ST
HOSP/BIRTHING CENTER CARE PER DAY NML NB
Initial hospital or birthing center care, per day, for evaluation and
management of normal newborn infant |
|
99461 |
1ST CARE PR
DAY NML NB XCPT HOSP/BIRTHING CENTER Initial care, per day, for evaluation
and management of normal newborn infant seen in other than hospital or
birthing center |
|
99462 |
SUBQ HOSPITAL
CARE PER DAY E/M NORMAL NEWBORN
Subsequent hospital care, per day, for evaluation and management of
normal newborn |
|
99463 |
1ST
HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT Initial hospital or birthing
center care, per day, for evaluation and management of normal newborn infant
admitted and discharged on the same date |
|
99464 |
ATTN AT
DELIVERY 1ST STABILIZATION OF NEWBORN
Attendance at delivery (when requested by the delivering physician or
other qualified health care professional) and initial stabilization of
newborn |
|
99465 |
DELIVERY/BIRTHING
ROOM RESUSCITATION
Delivery/birthing room resuscitation, provision of positive pressure
ventilation and/or chest compressions in the presence of acute inadequate
ventilation and/or cardiac output |
|
99466 |
CRITICAL CARE
INTERFACILITY TRANSPORT 30-74 MIN Critical care face-to-face services, during
an interfacility transport of critically ill or critically injured pediatric
patient, 24 months of age or younger; first 30-74 minutes of hands-on care
during transport |
|
99467 |
CRITICAL CARE
INTERFACILITY TRANSPORT EA 30 MIN Critical care face-to-face services, during
an interfacility transport of critically ill or critically injured pediatric
patient, 24 months of age or younger; each additional 30 minutes (List
separately in addition to code for primary service) |
|
99468 |
1ST INPATIENT
CRITICAL CARE PR DAY AGE 28 DAYS/<Initial inpatient neonatal critical
care, per day, for the evaluation and management of a critically ill neonate,
28 days of age or younger |
|
99469 |
SUBQ I/P
CRITICAL CARE PR DAY AGE 28 DAYS/<
Subsequent inpatient neonatal critical care, per day, for the
evaluation and management of a critically ill neonate, 28 days of age or
younger |
|
99471 |
INITIAL PED
CRITICAL CARE 29 DAYS THRU 24 MONTHS Initial inpatient pediatric critical care,
per day, for the evaluation and management of a critically ill infant or
young child, 29 days through 24 months of age |
|
99472 |
SUBSQ PED
CRITICAL CARE 29 DAYS THRU 24 MO
Subsequent inpatient pediatric critical care, per day, for the
evaluation and management of a critically ill infant or young child, 29 days
through 24 months of age |
|
99473 |
SELF-MEAS BP
PT EDUCAJ/TRAING & DEV CALIBRATION Self-measured blood pressure using a
device validated for clinical accuracy; patient education/training and device
calibration |
|
99474 |
SELF-MEAS BP
2 READG 1 MIN APART BID 30 DAY PD
Self-measured blood pressure using a device validated for clinical
accuracy; separate self-measurements of two readings one minute apart, twice
daily over a 30-day period (minimum of 12 readings), collection of data
reported by the patient and/or caregiver to the physician or other qualified
health care professional, with report of average systolic and diastolic
pressures and subsequent communication of a treatment plan to the patient |
|
99457 |
REMOTE
PHYSIOLOGIC MONITORING 1ST 20 MIN MONTH Remote physiologic monitoring
treatment management services, clinical staff/physician/other qualified
health care professional time in a calendar month requiring interactive
communication with the patient/caregiver during the month; first 20 minutes |
|
99458 |
REMOTE
PHYSIOLOGIC MONITORING EA ADDL 20 MIN MO Remote physiologic monitoring
treatment management services, clinical staff/physician/other qualified
health care professional time in a calendar month requiring interactive
communication with the patient/caregiver during the month; each additional 20
minutes (List separately in addition to code for primary procedure) |
|
99241 |
OFFICE
CONSULTATION NEW/ESTAB PATIENT 15 MIN
Office consultation for a new or established patient, which requires
these 3 key components: A problem focused history; A problem focused
examination; and Straightforward medical decision making. Counseling and/or
coordination of care with other physicians, other qualified health care
professionals, or agencies are provided consistent with the nature of the
problem(s) and the patient's and/or family's needs. Usually, the presenting
problem(s) are self limited or minor. Typically, 15 minutes are spent
face-to-face with the patient and/or family. |
|
99242 |
OFFICE
CONSULTATION NEW/ESTAB PATIENT 30 MIN
Office consultation for a new or established patient, which requires these
3 key components: An expanded problem focused history; An expanded problem
focused examination; and Straightforward medical decision making. Counseling
and/or coordination of care with other physicians, other qualified health
care professionals, or agencies are provided consistent with the nature of
the problem(s) and the patient's and/or family's needs. Usually, the
presenting problem(s) are of low severity. Typically, 30 minutes are spent
face-to-face with the patient and/or family. |
|
99243 |
OFFICE
CONSULTATION NEW/ESTAB PATIENT 40 MIN
Office consultation for a new or established patient, which requires
these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling
and/or coordination of care with other physicians, other qualified health
care professionals, or agencies are provided consistent with the nature of
the problem(s) and the patient's and/or family's needs. Usually, the
presenting problem(s) are of moderate severity. Typically, 40 minutes are
spent face-to-face with the patient and/or family. |
|
99244 |
OFFICE
CONSULTATION NEW/ESTAB PATIENT 60 MIN
Office consultation for a new or established patient, which requires
these 3 key components: A comprehensive history; A comprehensive examination;
and Medical decision making of moderate complexity.
Counseling and/or coordination of care with other physicians, other qualified
health care professionals, or agencies are provided consistent with the
nature of the problem(s) and the patient's and/or family's needs. Usually,
the presenting problem(s) are of moderate to high severity. Typically, 60
minutes are spent face-to-face with the patient and/or family. |
|
99245 |
OFFICE
CONSULTATION NEW/ESTAB PATIENT 80 MIN
Office consultation for a new or established patient, which requires
these 3 key components: A comprehensive history; A comprehensive examination;
and Medical decision making of high complexity.
Counseling and/or coordination of care with other physicians, other qualified
health care professionals, or agencies are provided consistent with the
nature of the problem(s) and the patient's and/or family's needs. Usually,
the presenting problem(s) are of moderate to high severity. Typically, 80
minutes are spent face-to-face with the patient and/or family. |
|
99251 |
INITIAL
INPATIENT CONSULT NEW/ESTAB PT 20 MIN
Inpatient consultation for a new or established patient, which
requires these 3 key components: A problem focused history; A problem focused
examination; and Straightforward medical decision making. Counseling and/or
coordination of care with other physicians, other qualified health care
professionals, or agencies are provided consistent with the nature of the
problem(s) and the patient's and/or family's needs. Usually, the presenting
problem(s) are self limited or minor. Typically, 20 minutes are spent at the
bedside and on the patient's hospital floor or unit. |
|
99252 |
INITIAL
INPATIENT CONSULT NEW/ESTAB PT 40 MIN
Inpatient consultation for a new or established patient, which
requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination; and Straightforward medical decision
making. Counseling and /or coordination of care with other physicians, other
qualified health care professionals, or agencies are provided consistent with
the nature of the problem(s) and the patient's and/or family's needs.
Usually, the presenting problem(s) are of low severity. Typically, 40 minutes
are spent at the bedside and on the patient's hospital floor or unit. |
|
99253 |
INITIAL
INPATIENT CONSULT NEW/ESTAB PT 55 MIN
Inpatient consultation for a new or established patient, which
requires these 3 key components: A detailed history; A detailed examination;
and Medical decision making of low complexity.
Counseling and/or coordination of care with ot her
physicians, other qualified health care professionals, or agencies are
provided consistent with the nature of the problem(s) and the patient's
and/or family's needs. Usually, the presenting problem(s) are of moderate
severity. Typically, 55 minutes are spent at the bedside and on the patient's
hospital floor or unit. |
|
99254 |
INITIAL
INPATIENT CONSULT NEW/ESTAB PT 80 MIN
Inpatient consultation for a new or established patient, which
requires these 3 key components: A comprehensive history; A comprehensive
examination; and Medical decision making of moderate
complexity. Counseling and/or coordination of care with other physicians,
other qualified health care professionals, or agencies are provided
consistent with the nature of the problem(s) and the patient's and/or
family's needs. Usually, the presenting problem(s) are of moderate to high
severity. Typically, 80 minutes are spent at the bedside and on the patient's
hospital floor or unit. |
|
99255 |
INITIAL
INPATIENT CONSULT NEW/ESTAB PT 110 MIN Inpatient consultation for a new or
established patient, which requires these 3 key components: A comprehensive
history; A comprehensive examination; and Medical decision making of high
complexity. Counseling and/or coordination of care with other physicians,
other qualified health care professionals, or agencies are provided
consistent with the nature of the problem(s) and the patient's and/or
family's needs. Usually, the presenting problem(s) are of moderate to high
severity. Typically, 110 minutes are spent at the bedside and on the
patient's hospital floor or unit. |
|
99360 |
PHYS STANDBY
SVC PROLNG PHYS ATTN EA 30 MINUTES Standby service, requiring prolonged
attendance, each 30 minutes (eg, operative standby, standby for frozen
section, for cesarean/high risk delivery, for monitoring EEG) |
|
99415 |
PROLONGED
CLINICAL STAFF SVC OFFICE/O/P 1ST HR Prolonged clinical staff service
(the service beyond the highest time in the range of total time of the
service) during an evaluation and management service in the office or
outpatient setting, direct patient contact with physician supervision; first
hour (List separately in addition to code for outpatient Evaluation and
Management service) |
|
99416 |
PROLONGED
CLINICAL STAFF SVC OFFICE/O/P EA ADDL Prolonged clinical staff service (the
service beyond the highest time in the range of total time of the service)
during an evaluation and management service in the office or outpatient
setting, direct patient contact with physician supervision; each additional
30 minutes (List separately in addition to code for prolonged service) |
|
99417 |
PROLONGED
OFFICE/OUTPATIENT E/M SVC EA 15 MIN
Prolonged office or other outpatient evaluation and management
service(s) beyond the minimum required time of the primary procedure which
has been selected using total time, requiring total time with or without
direct patient contact beyond the usual service, on the date of the primary
service, each 15 minutes of total time (List separately in addition to codes
99205, 99215 for office or other outpatient Evaluation and Management
services) |
|
99381 |
INITIAL
PREVENTIVE MEDICINE NEW PATIENT <1YEAR Initial comprehensive preventive
medicine evaluation and management of an individual including an age and
gender appropriate history, examination, counseling/anticipatory
guidance/risk factor reduction interventions, and the ordering of
laboratory/diagnostic procedures, new patient; infant (age younger than 1
year) |
|
99382 |
INITIAL
PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS Initial comprehensive preventive
medicine evaluation and management of an individual including an age and
gender appropriate history, examination, counseling/anticipatory
guidance/risk factor reduction interventions, and the ordering of
laboratory/diagnostic procedures, new patient; early childhood (age 1 through
4 years) |
|
99383 |
INITIAL
PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS Initial comprehensive preventive
medicine evaluation and management of an individual including an age and
gender appropriate history, examination, counseling/anticipatory
guidance/risk factor reduction interventions, and the ordering of
laboratory/diagnostic procedures, new patient; late childhood (age 5 through
11 years) |
|
99384 |
INITIAL
PREVENTIVE MEDICINE NEW PT AGE 12-17 YR Initial comprehensive preventive
medicine evaluation and management of an individual including an age and
gender appropriate history, examination, counseling/anticipatory
guidance/risk factor reduction interventions, and the ordering of
laboratory/diagnostic procedures, new patient; adolescent (age 12 through 17
years) |
|
99385 |
INITIAL
PREVENTIVE MEDICINE NEW PT AGE 18-39YRS Initial comprehensive preventive
medicine evaluation and management of an individual including an age and
gender appropriate history, examination, counseling/anticipatory
guidance/risk factor reduction interventions, and the ordering of
laboratory/diagnostic procedures, new patient; 18-39 years |
|
99386 |
INITIAL
PREVENTIVE MEDICINE NEW PATIENT 40-64YRSInitial comprehensive preventive
medicine evaluation and management of an individual including an age and
gender appropriate history, examination, counseling/anticipatory
guidance/risk factor reduction interventions, and the ordering of
laboratory/diagnostic procedures, new patient; 40-64 years |
|
99387 |
INITIAL
PREVENTIVE MEDICINE NEW PATIENT 65YRS&> Initial comprehensive
preventive medicine evaluation and management of an individual including an
age and gender appropriate history, examination, counseling/anticipatory
guidance/risk factor reduction interventions, and the ordering of
laboratory/diagnostic procedures, new patient; 65 years and older |
|
99421 |
ONLINE
DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES Online digital evaluation and
management service, for an established patient, for up to 7 days, cumulative
time during the 7 days; 5-10 minutes |
|
99422 |
ONLINE
DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES Online digital evaluation and
management service, for an established patient, for up to 7 days, cumulative
time during the 7 days; 11-20 minutes |
|
99423 |
ONLINE
DIGITAL E/M SVC EST PT <7 D 21+ MINUTES Online digital evaluation and
management service, for an established patient, for up to 7 days, cumulative
time during the 7 days; 21 or more minutes |
|
99429 |
UNLISTED
PREVENTIVE MEDICINE SERVICE |
|
98966 |
NONPHYSICIAN TELEPHONE
ASSESSMENT 5-10 MIN Telephone
assessment and management service provided by a qualified nonphysician health
care professional to an established patient, parent, or guardian not
originating from a related assessment and management service provided within
the previous 7 days nor leading to an assessment and management service or
procedure within the next 24 hours or soonest available appointment;
5-10 minutes of medical discussion |
|
98967 |
NONPHYSICIAN
TELEPHONE ASSESSMENT 11-20 MIN
Telephone assessment and management service provided by a qualified
nonphysician health care professional to an established patient, parent, or
guardian not originating from a related assessment and management service
provided within the previous 7 days nor leading to an assessment and
management service or procedure within the next 24 hours or soonest available
appointment; 11-20 minutes of medical discussion |
|
98968 |
NONPHYSICIAN
TELEPHONE ASSESSMENT 21-30 MIN
Telephone assessment and management service provided by a qualified
nonphysician health care professional to an established patient, parent, or
guardian not originating from a related assessment and management service
provided within the previous 7 days nor leading to an assessment and
management service or procedure within the next 24 hours or soonest available
appointment; 21-30 minutes of medical discussion |
|
99441 |
PHYS/QHP
TELEPHONE EVALUATION 5-10 MIN.
Telephone evaluation and management service by a physician or other
qualified health care professional who may report evaluation and management
services provided to an established patient, parent, or guardian not
originating from a related E/M service provided within the previous 7 days
nor leading to an E/M service or procedure within the next 24 hours or
soonest available appointment; 5-10 minutes of
medical discussion |
|
99442 |
PHYS/QHP
TELEPHONE EVALUATION 11-20 MIN . Telephone
evaluation and management service by a physician or other qualified health
care professional who may report evaluation and management services provided
to an established patient, parent, or guardian not originating from a related
E/M service provided within the previous 7 days nor leading to an E/M service
or procedure within the next 24 hours or soonest available appointment;
11-20 minutes of medical discussion |
|
99443 |
PHYS/QHP
TELEPHONE EVALUATION 21-30 MIN. Telephone evaluation and management service
by a physician or other qualified health care professional who may report
evaluation and management services provided to an established patient,
parent, or guardian not originating from a related E/M service provided
within the previous 7 days nor leading to an E/M service or procedure within
the next 24 hours or soonest available appointment;
21-30 minutes of medical discussion |
|
99446 |
NTRPROF
PHONE/NTRNET/EHR ASSMT&MGMT 5-10 MIN
Interprofessional telephone/Internet/electronic health record
assessment and management service provided by a consultative physician,
including a verbal and written report to the patient's treating/requesting
physician or other qualified health care professional; 5-10 minutes of
medical consultative discussion and review |
|
99447 |
NTRPROF
PHONE/NTRNET/EHR ASSMT&MGMT 11-20 MIN
Interprofessional telephone/Internet/electronic health record
assessment and management service provided by a consultative physician,
including a verbal and written report to the patient's treating/requesting
physician or other qualified health care professional; 11-20 minutes of
medical consultative discussion and review |
|
99448 |
NTRPROF
PHONE/NTRNET/EHR ASSMT&MGMT 21-30 MIN
Interprofessional telephone/Internet/electronic health record
assessment and management service provided by a consultative physician,
including a verbal and written report to the patient's treating/requesting
physician or other qualified health care professional; 21-30 minutes of
medical consultative discussion and review |
|
99449 |
NTRPROF
PHONE/NTRNET/EHR ASSMT&MGMT 31/> MIN
Interprofessional telephone/Internet/electronic health record
assessment and management service provided by a consultative physician,
including a verbal and written report to the patient's treating/requesting
physician or other qualified health care professional; 31 minutes or more of
medical consultative discussion and review |
|
G0425 |
Telehealth
consultation, emergency department or initial inpatient, typically 30 minutes
communicating with the patient via telehealth as maintained by CMS falls
under Initial Telehealth Consultations |
|
G0426 |
Telehealth
consultation, emergency department or initial inpatient, typically 50 minutes
communicating with the patient via telehealth as maintained by CMS falls
under Initial Telehealth Consultations. |
|
G0427 |
Telehealth
consultation, emergency department or initial inpatient, typically 70 minutes
or more communicating with the patient via telehealth as maintained by CMS
falls under Initial Telehealth Consultations. |
|
G0459 |
Inpatient
telehealth pharmacologic management, including prescription, use, and review
of medication with no more than minimal medical psychotherapy as maintained
by CMS falls under Miscellaneous Services. |
|
T1014 |
Telehealth
transmission, per minute, professional services bill separately as maintained
by CMS falls under Other Services. |
|
92002 |
OPHTH MEDICAL
XM&EVAL INTERMEDIATE NEW PT
Ophthalmological services: medical examination and evaluation with
initiation of diagnostic and treatment program; intermediate, new patient |
|
92004 |
OPHTH MEDICAL
XM&EVAL COMPRE NEW PT 1/> VST
Ophthalmological services: medical examination and evaluation with
initiation of diagnostic and treatment program; comprehensive, new patient, 1
or more visits |
|
92012 |
OPHTH MEDICAL
XM&EVAL INTERMEDIATE ESTAB PT
Ophthalmological services: medical examination and evaluation, with
initiation or continuation of diagnostic and treatment program; intermediate,
established patient |
|
92014 |
OPHTH MEDICAL
XM&EVAL COMPRHNSV ESTAB PT 1/>
Ophthalmological services: medical examination and evaluation, with
initiation or continuation of diagnostic and treatment program;
comprehensive, established patient, 1 or more visits |
|
99201 |
Office or
other outpatient visit for the evaluation and
management of a new patient, which requires these three key components: a
problem focused history; a problem focused examination; and straightforward
medical decision making. Physicians typically spend 10 minutes face-to-face
with the patient and/or family. |
|
99202 |
Office or
other outpatient visit for the evaluation and management of a new patient,
which requires these three key components: an expanded problem focused
history; an expanded problem focused examination; and straightforward medical
decision making. Physicians typically spend 20 minutes face-to-face with the
patient and/or family. |
|
99203 |
Office or
other outpatient visit for the evaluation and management of a new patient,
which requires these three key components: a detailed history; a detailed
examination; and medical decision making of low complexity. Physicians
typically spend 30 minutes face-to-face with the patient and/or family. |
|
99204 |
Office or other
outpatient visit for the evaluation and management of a new patient, which
requires these three key components: a comprehensive history; a comprehensive
examination; and medical decision making of moderate
complexity. Physicians typically spend 45 minutes face-to-face
with the patient and/or family. |
|
99205 |
Office or
other outpatient visit for the evaluation and
management of a new patient, which requires these three key components: a
comprehensive history; a comprehensive examination; and medical decision
making of high complexity. Physicians
typically spend 60 minutes face-to-face with the patient and/or family. |
|
99211 |
Office or
other outpatient visit for the evaluation and
management of an established patient that may not require the presence of a
physician. Usually, the presenting problem(s) are minimal. Typically, 5
minutes are spent performing or supervising these services. |
|
99212 |
Office or
other outpatient visit for the evaluation and management of an established
patient, which requires at least two of these three components to be present
in the medical record: A problem focused history; a problem focused
examination; or decision making regarding treatment
is straightforward. Physicians typically spend 10 minutes face-to-face with
the patient and/or family. |
|
99213 |
Office or
other outpatient visit for the evaluation and management of an established
patient, which requires at least two of these three components to be present
in the medical record: A problem focused history; a problem focused
examination; or decision making regarding treatment
is low complexity. Physicians typically spend 15 minutes face-to-face with
the patient and/or family. |
|
99214 |
Office or
other outpatient visit for the evaluation and management of an established
patient, which requires at least two of these three components to be present
in the medical record: A problem focused history; a problem focused
examination; or decision making regarding treatment
is moderate complexity. Physicians typically spend 25 minutes face-to-face
with the patient and/or family. |
|
99215 |
Office or
other outpatient visit for the evaluation and management of an established
patient, which requires at least two of these three components to be present
in the medical record: A problem focused history; a problem focused
examination; or decision making regarding treatment
is high complexity. Physicians typically spend 40 minutes face-to-face with
the patient and/or family. |
|
99354 |
Prolonged
evaluation and management or psychotherapy service(s) (beyond the typical
service time of the primary procedure) in the office or other outpatient
setting requiring direct patient contact beyond the usual service; first hour
(List separately in addition to code for office or other outpatient
Evaluation and Management or psychotherapy service) |
|
99355 |
Prolonged
evaluation and management or psychotherapy service(s) (beyond the typical service
time of the primary procedure) in the office or other outpatient setting
requiring direct patient contact beyond the usual service; each additional 30
minutes (List separately in addition to code for prolonged service) |
|
99356 |
Prolonged
service in the inpatient setting or observation setting, requiring unit/floor
time beyond the usual service; first hour (List separately in addition to
code for inpatient Evaluation and Management service) |
|
99357 |
Prolonged
service in the inpatient or observation setting, requiring unit/floor time
beyond the usual service; each additional 30 minutes (List separately in
addition to code for prolonged physician service) |
|
99358 |
Prolonged
evaluation and management service before and/or after direct patient care;
first hour |
|
99359 |
Prolonged
evaluation and management service before and/or after direct patient care;
each additional 30 minutes (List separately in addition to code for prolonged
service) |
|
99391 |
Periodic
comprehensive preventive medicine reevaluation and management of an
individual including an age and gender appropriate history, examination,
counseling/anticipatory guidance/risk factor reduction interventions, and the
ordering of laboratory/diagnostic procedures, established patient; infant |
|
99392 |
Periodic
comprehensive preventive medicine reevaluation and management of an
individual including an age and gender appropriate history, examination,
counseling/anticipatory guidance/risk factor reduction interventions, and the
ordering of laboratory/diagnostic procedures, established patient; early
childhood (1-4) |
|
99393 |
Periodic
comprehensive preventive medicine reevaluation and management of an
individual including an age and gender appropriate history, examination,
counseling/anticipatory guidance/risk factor reduction interventions, and the
ordering of laboratory/diagnostic procedures, established patient; late
childhood (5-11) |
|
99394 |
Periodic comprehensive
preventive medicine reevaluation and management of an individual including an
age and gender appropriate history, examination, counseling/anticipatory
guidance/risk factor reduction interventions, and the ordering of
laboratory/diagnostic procedures, established patient; adolescent (12-17) |
|
99395 |
Periodic
comprehensive preventive medicine reevaluation and management of an
individual including an age and gender appropriate history, examination,
counseling/anticipatory guidance/risk factor reduction interventions, and the
ordering of laboratory/diagnostic procedures, established patient; 18-39
years |
|
99396 |
Periodic
comprehensive preventive medicine reevaluation and management of an
individual including an age and gender appropriate history, examination,
counseling/anticipatory guidance/risk factor reduction interventions, and the
ordering of laboratory/diagnostic procedures, established patient; 40-64
years |
|
99397 |
Periodic
comprehensive preventive medicine reevaluation and management of an
individual including an age and gender appropriate history, examination,
counseling/anticipatory guidance/risk factor reduction interventions, and the
ordering of laboratory/diagnostic procedures, established patient; 65 years
and older |
|
Telehealth |
Recognized by
Place of Service (POS) 02 or appending modifier GT, GQ, G0 or 95. |
Last
Updated 01/01/2025