E & M coding changes- effective January 1, 2021


Beginning Jan 1, 2021, there are significant changes coming to E/M (Evaluation and Management) coding.  CMS (Medicare) has simplified the documentation needed to reduce the burden on providers.


A few highlights include:

  • CPT 99201 (level 1, new patient) will be deleted
  • Changes to E/M documentation apply to CPT 99202-99205 and 99211-99215 only.
  • A new code, CPT 99417 for "addition of a 15-min prolonged service" will be added that can be used with 99205 and 99215. 
  • A new HCPCS code GPCX1 "visit complexity" will be created.  Can be used on all levels.  Reimbursement will be around $12
  • H & P as elements for code selection will be eliminated.
  • Providers no longer have to re-document the patients history; only changes that have happened since their last visit.
  • Per AMA, the changes to E/M code selection apply to Medicare, Medicaid and all commercial payers. 
    • Commercial payers are not required to adopt HCPCS code for visit complexity.




There is a great article listing all of the code/guideline changes in this link:


In the 5th paragraph, click on the word "description", and the pdf will present.






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