Description | Codes | Explanations | Work RVU | Total RVU | Complexity of Data | Risk of Morbidity |
---|---|---|---|---|---|---|
Subsequent Hospital Care Level I, 15 minutes | 99231 | 99231 - 0.76 | 99231 - 1.11 | |||
Subsequent Hospital Care Level II, 25 minutes | 99232 | 99232 - 1.39 | 99232 - 2.04 | |||
Subsequent Hospital Care Level III, 35 minutes | 99233 | 99233 - 2.00 | 99233 - 2.95 | |||
Emergency Dept - New or Established I | 99281 | 99281 - 0.45 | 99281 - 0.60 | |||
Emergency Dept - New or Established II | 99282 | 99282 - 0.88 | 99282 - 1.17 | |||
Emergency Dept - New or Established III | 99283 | 99283 - 1.34 | 99283 - 1.75 | |||
Emergency Dept - New or Established IV | 99284 | 99284 - 2.56 | 99284 - 3.32 | |||
Emergency Dept - New or Established V | 99285 | 99285 - 3.80 | 99285 - 4.90 | |||
Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure | 99024 | Starting July 1, 2017, for Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island, this code now must be on Medicare fee-for-service claims for outpatient and inpatient post-operative follow-up visits. | 99024 - 0.00 | 99024 - 0.00 | ||
Hospital Discharge Day | 99239 | >30 minutes | 99239 - 1.90 | 99239 - 3.04 | ||
Hospital Discharge Day | 99238 | <30 minutes | 99238 - 1.28 | 99238 - 2.05 | ||
Critical Care Total Time | 99291 | 1st 30 - 74 min | 99291 - 4.50 | 99291 - 6.32 | ||
Critical Care Total Time | 99292 | Plus 30 min | 99292 - 2.25 | 99292 - 3.17 | ||
Initial Inpatient Consult Level I, 20 minutes | 99251 | This code is NOT Medicare allowable code for hospital history and physical and consults. It may be allowable and paid by other payers. | 99251 - 1.00 | 99251 - 1.38 | ||
Initial Inpatient Consult Level II, 40 minutes | 99252 | This code is NOT Medicare allowable code for hospital history and physical and consults. It may be allowable and paid by other payers. | 99252 - 1.50 | 99252 - 2.11 | ||
Initial Inpatient Consult Level III, 55 minutes | 99253 | This code is NOT Medicare allowable code for hospital history and physical and consults. It may be allowable and paid by other payers. | 99253 - 2.27 | 99253 - 3.24 | ||
Initial Inpatient Consult Level IV, 80 minutes | 99254 | This code is NOT Medicare allowable code for hospital history and physical and consults. It may be allowable and paid by other payers. | 99254 - 3.29 | 99254 - 4.71 | ||
Initial Inpatient Consult Level V, 110 minutes | 99255 | This code is NOT Medicare allowable code for hospital history and physical and consults. It may be allowable and paid by other payers. | 99255 - 4.00 | 99255 - 5.68 | ||
Initial Hospital Care Level I, 30 minutes | 99221 | This code is the Medicare allowable code for hospital history & physical and consults. | 99221 - 1.92 | 99221 - 2.87 | ||
Initial Hospital Care Level II, 50 minutes | 99222 | This code is the Medicare allowable code for hospital history & physical and consults. | 99222 - 2.61 | 99222 - 3.87 | ||
Initial Hospital Care Level III, 70 minutes | 99223 | This code is the Medicare allowable code for hospital history & physical and consults. | 99223 - 3.86 | 99223 - 5.73 | ||
Observation care discharge | 99217 | 99217 - 1.28 | 99217 - 2.06 | |||
Initial observation care, 30 minutes | 99218 | 99218 - 1.92 | 99218 - 2.82 | |||
Initial observation care, 50 minutes | 99219 | 99219 - 2.60 | 99219 - 3.84 | |||
Initial observation care, 70 minutes | 99220 | 99220 - 3.56 | 99220 - 5.25 | |||
Office consultation, 15 minutes | 99241 | 99241 - 0.64 | 99241 - 0.92 | |||
Office consultation, 30 minutes | 99242 | 99242 - 1.34 | 99242 - 1.93 | |||
Office consultation, 40 minutes | 99243 | 99243 - 1.88 | 99243 - 2.70 | |||
Office consultation, 60 minutes | 99244 | 99244 - 3.02 | 99244 - 6.04 | |||
Office consultation, 80 minutes | 99245 | 99245 - 3.77 | 99245 - 7.54 | |||
Office or other outpatient visit for the evaluation, 10 minutes | 99201 | 99201 - 0.48 | 99201 - 0.96 | |||
Office or other outpatient visit for the evaluation, 15-29 minutes | 99202 | Minimal; 1 self-limited or minor problem | 99202 - 0.93 | 99202 - 1.86 | Minimal or none | Minimal risk of morbidity from additional diagnostic testing or treatment |
Office or other outpatient visit for the evaluation, 30-44 minutes | 99203 | Low; 2 or more self-limited or minor problems; 1 stable chronic illness; 1 acute, uncomplicated illness or injury | 99203 - 1.42 | 99203 - 2.84 | Limited (must meet the requirements of at least 1 of the 2 categories) Category 1: Tests and documents Any combination of 2 from the following: Review of the prior external note(s) from each unique source; review of the result(s) of each unique test; ordering of each unique test or Category 2: Assessment requiring an independent hisotrian(s) (for the categories of independent interpretation of tests and discussion of management or test interpretation, see moderate or high) | Low risk of morbidity from additional diagnostic testing or treatment |
Office or other outpatient visit for the evaluation, 45-59 minutes | 99204 | Moderate; 1 or more chronic illnesses with exacerbation, progression or side effects of treatment; 2 or more stable chronic illness; 1 undiagnosed new problem with uncertain prognosis; 1 acute illness with systemic symptoms; 1 acute complicated injury | 99204 - 2.43 | 99204 - 4.86 | Moderate (must meet the requirements of at least 1 out of 3 categories) Category 1: Tests and documents or independent historian(s) Any combination of 3 from the following: Review of the prior external note(s) from each unique source; review of the result(s) of each unique test; ordering of each unique test Assessment requiring an independent historian(s) or Category 2: Independent interpretation of tests Independent interpretation of a test performed by another physician/other qualified health care professional (not separately reported); or Category 3: Discussion of management or test interpretation Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported) | Moderate risk of morbidity from additional diagnostic testing or treatment |
Office or other outpatient visit for the evaluation, 60-74 minutes | 99205 | High; 1 or more chronic illnesses with exacerbation, progression or side effects of treatment; 1 acute or chronic illness or injury that poses a threat to life or bodily function. | 99205 - 3.17 | 99205 - 6.34 | Extensive (must meet the requirements of at least 2 out of 3 categories) Category 1: Tests and documents or independent historian(s) Any combination of 3 from the following: Review of the prior external note(s) from each unique source; review of the result(s) of each unique test; ordering of each unique test Assessment requiring an independent historian(s) or Category 2: Independent interpretation of tests Independent interpretation of a test performed by another physician/other qualified health care professional (not separately reported); or Category 3: Discussion of management or test interpretation Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported) | High risk of morbidity from additional diagnostic testing or treatment |
Office/outpatient visit N/A | 99211 | Does not require a clinician and visit may be done by office staff | 99211 - 0.18 | 99211 - 0.36 | ||
Office/outpatient visit est, 10-19 minutes | 99212 | Minimal; 1 self-limited or minor problem | 99212 - 0.48 | 99212 - 0.96 | Minimal or none | Minimal risk of morbidity from additional diagnostic testing or treatment |
Office/outpatient visit est, 20-29 minutes | 99213 | Low; 2 or more self-limited or minor problems; 1 stable chronic illness; 1 acute, uncomplicated illness or injury | 99213 - 0.97 | 99213 - 1.94 | Limited (must meet the requirements of at least 1 of the 2 categories. Category 1: Tests and documents Any combination of 2 from the following: Review of the prior external note(s) from each unique source; review of the result(s) of each unique test; ordering of each unique test or Category 2: Assessment requiring an independent hisotrian(s) (for the categories of independent interpretation of tests and discussion of management or test interpretation, see moderate or high) | Low risk of morbidity from additional diagnostic testing or treatment |
Office/outpatient visit est, 30-39 minutes | 99214 | Moderate; 1 or more chronic illnesses with exacerbation, progression or side effects of treatment; 2 or more stable chronic illness; 1 undiagnosed new problem with uncertain prognosis; 1 acute illness with systemic symptoms; 1 acute complicated injury | 99214 - 1.50 | 99214 - 3.00 | Moderate (must meet the requirements of at least 1 out of 3 categories) Category 1: Tests and documents or independent historian(s) Any combination of 3 from the following: Review of the prior external note(s) from each unique source; review of the result(s) of each unique test; ordering of each unique test Assessment requiring an independent historian(s) or Category 2: Independent interpretation of tests Independent interpretation of a test performed by another physician/other qualified health care professional (not separately reported); or Category 3: Discussion of management or test interpretation Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported) | Moderate risk of morbidity from additional diagnostic testing or treatment |
Office/outpatient visit est, 40-54 minutes | 99215 | High; 1 or more chronic illnesses with exacerbation, progression or side effects of treatment; 1 acute or chronic illness or injury that poses a threat to life or bodily function. | 99215 - 2.11 | 99215 - 4.22 | Extensive (must meet the requirements of at least 2 out of 3 categories) Category 1: Tests and documents or independent historian(s) Any combination of 3 from the following: Review of the prior external note(s) from each unique source; review of the result(s) of each unique test; ordering of each unique test Assessment requiring an independent historian(s) or Category 2: Independent interpretation of tests Independent interpretation of a test performed by another physician/other qualified health care professional (not separately reported); or Category 3: Discussion of management or test interpretation Discussion of management or test interpretation with external physician/other qualified health care professional/appropriate source (not separately reported) | High risk of morbidity from additional diagnostic testing or treatment |
Reimbursable PR2 chart notes | 99081 | 99081 - 0.00 | 99081 - 0.00 | |||
Phone call 5 to 10 minutes of medical discussion | 98966 | 98966 - 0.25 | 98966 - 0.5 | |||
Phone call 11 to 20 minutes of medical discussion | 98967 | 98967 - 0.50 | 98967 - 1.00 | |||
Phone call 21 to 30 minutes of medical discussion | 98968 | 98968 - 0.75 | 98968 - 1.50 | |||
Email or some other online service to discuss a medical problem with a physician. | 99444 | 99444 - 0.00 | 99444 - 0.00 | |||
Email or some other online service to discuss a medical problem with a physician extender. | 98969 | 98969 - 0.00 | 98969 - 0.00 | |||
5-10 minutes of medical consultative discussion and review | 99446 | 99446 - 0.35 | 99446 - 0.70 | |||
11-20 minutes of medical consultative discussion and revie | 99447 | 99447 - 0.70 | 99447 - 1.40 | |||
21-30 minutes of medical consultative discussion and review | 99448 | 99448 - 1.05 | 99448 - 2.10 | |||
31 minutes or more of medical consultative discussion and review | 99449 | 99449 - 1.40 | 99449 - 2.80 | |||
Sign language or oral interpretive services, per 15 minutes | T1013 | T1013 - 0 | T1013 - 0 | |||
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 | 99451 | 99451 - 0.70 | 99451 - 1.40 | |||
Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes | 99452 | 99452 - 0.70 | 99452 - 1.40 | |||
Prolonged evaluation and management service before and/or after direct patient care; first hour | 99358 | 99358 - 1.80 | 99358 - 3.60 | |||
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) | 99359 | 99359 - 0.75 | 99359 - 1.50 | |||
ADL 15mins | 97535 | 97535 - 0.45 | 97535 - 0.90 | |||
PR4 P&S (1st page) | WC004-0000 | WC004-0000 - 0 | WC004-0000 - 0 | |||
PR4 P&S (each additional page) | WC004-0001 | WC004-0001 - 0 | WC004-0001 - 0 |