Intro25

Good 👍 Vijay, this is CPT 2026 – Evaluation & Management (E/M) Tables section.
This is VERY important for your CPC exam.

I will explain in simple exam-friendly way.

🔹 MAIN RULE (Most Important for CPC)

For almost all E/M codes (2021+ guidelines):

You select the code based on:

👉 1. Medical Decision Making (MDM)
OR
👉 2. Total Time (on date of encounter)

✔ History and Exam must be medically appropriate
❌ They do NOT decide the level anymore

1️⃣ Office or Other Outpatient Services

🟢 New Patient (99202–99205)

Code MDM Level Time (Minutes)
99202 Straightforward 15
99203 Low 30
99204 Moderate 45
99205 High 60

📌 Exam Tip: New patient = not seen by same provider in last 3 years.

🔵 Established Patient (99211–99215)

Code MDM Level Time (Minutes)
99211 Minimal (no MDM required) N/A
99212 Straightforward 10
99213 Low 20
99214 Moderate 30
99215 High 40

📌 99211 = nurse visit, no physician MDM needed.

2️⃣ Telemedicine

🎥 Audio-Video (Real-time video)

Codes:

  • New: 98000–98003
  • Established: 98004–98007

Same MDM levels & time structure as office visits.

📞 Audio-Only (Phone)

New:

98008–98011 (15–60 mins)

Established:

98012–98015 (10–40 mins)

Must be: ✔ More than 10 minutes medical discussion

📱 Brief Communication (Established only)

✔ 98016
✔ 5–10 minutes only

Very short discussion.

3️⃣ Hospital Services

🏥 Initial Hospital Care (99221–99223)

Code MDM Time
99221 Low 40 min
99222 Moderate 55 min
99223 High 75 min

🔁 Subsequent Hospital Care (99231–99233)

Code MDM Time
99231 Low 25 min
99232 Moderate 35 min
99233 High 50 min

🚪 Admission + Discharge Same Day (99234–99236)

Code MDM Time
99234 Low 45
99235 Moderate 70
99236 High 85

4️⃣ Consultations

🏢 Office Consult (99242–99245)

Code MDM Time
99242 Straightforward 20
99243 Low 30
99244 Moderate 40
99245 High 55

🏥 Inpatient Consult (99252–99255)

Code MDM Time
99252 Straightforward 35
99253 Low 45
99254 Moderate 60
99255 High 80

5️⃣ Emergency Department (99281–99285)

Selected ONLY by MDM
Time does NOT matter.

Code MDM
99281 Minimal
99282 Low
99283 Moderate
99284 Moderate (higher)
99285 High

6️⃣ Nursing Facility

Initial: 99304–99306

Subsequent: 99307–99310

Based on MDM OR Time.

7️⃣ Home/Residence Services

New: 99341–99345

Established: 99347–99350

Selected by MDM OR Time.

8️⃣ Critical Care

Adult Critical Care

  • 99291 → 30–74 minutes
  • 99292 → Each additional 30 minutes

Example: 90 minutes
= 99291 + 99292

9️⃣ Neonatal & Pediatric Critical Care

Codes based on:

  • Age
  • Weight
  • Initial vs Subsequent

Example:

  • 99468 → Neonatal initial
  • 99469 → Neonatal subsequent
  • 99477 → Initial neonatal intensive care

Very important for pediatric specialty.

🔥 CPC EXAM STRATEGY

When question comes:

1️⃣ Identify Setting
Office? Hospital? ER? Nursing? Home?

2️⃣ Identify Patient Type
New or Established?

3️⃣ Check MDM Level
Straightforward / Low / Moderate / High

4️⃣ If time given → Match with time table

5️⃣ Choose correct code

🎯 Most Tested in CPC

✔ 99202–99205
✔ 99212–99215
✔ 99221–99223
✔ 99231–99233
✔ 99291

Focus more on these.


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. 🔹 MAIN RULE (Most Important for CPC) For almost all E/M codes (2021+ guidelines): You select the code based on: 👉 1. Medical Decision Making (MDM) OR 👉 2. Total Time (on date of encounter) ✔ History and Exam must be medically appropriate ❌ They do NOT decide the level anymore 1️⃣ Office or Other Outpatient Services 🟢 New Patient (99202–99205) Code MDM Level Time (Minutes) 99202 Straightforward 15 99203 Low 30 99204 Moderate 45 99205 High 60 📌 Exam Tip: New patient = not seen by same provider in last 3 years. 🔵 Established Patient (99211–99215) Code MDM Level Time (Minutes) 99211 Minimal (no MDM required) N/A 99212 Straightforward 10 99213 Low 20 99214 Moderate 30 99215 High 40 📌 99211 = nurse visit, no physician MDM needed. 2️⃣ Telemedicine 🎥 Audio-Video (Real-time video) Codes: New: 98000–98003 Established: 98004–98007 Same MDM levels & time structure as office visits. 📞 Audio-...
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