In alignment with the Office and Outpatient Evaluation and Management (E/M) Coding Guidelines changes that were effective January 1, 2021, the following code sets were revised January 1, 2023:

  • Non-Office E/M codes (99221–99223, 99231–99239)
  • Consultation codes (99242–99245, 99252–99255)*
  • Emergency Department codes (99281–99285)
  • Nursing Facility Service codes (99304–99310, 99315, 99316)
  • Home or Residence Service codes (99341, 99342, 99344, 99345, 99347–99350)

*Please refer to Reimbursement Policy RP-063 for additional information related to Consultation Services.

Time or Medical Decision Making

Except for Emergency Department codes (99281–99285), providers may choose the appropriate E/M level of care based on either Time or Medical Decision Making (MDM). Emergency Department codes (99281–99285) use only MDM to determine level of care.

Documentation Guidelines

Please see the Documentation Guidelines for E/M Services 2023 for additional details on how to correctly report these services. To access the 2023 Documentation Guidelines — as well as 2023 Auditor’s Scoring Worksheets and a revised list of frequently asked questions — visit the Provider Resource Center (PRC).

Once there, select CLAIMS, PAYMENT & REIMBURSEMENT from the left menu, click Documentation Guidelines For Evaluation And Management Services, and then go to 2023 RESOURCE LINKS on that page.