Blended rates for paying evaluation & management codes have been postponed. It was proposed and part of the Final Rule in 2019 to pay a single rate for levels 2 through 4 and use time as the determining factor.
Medicare’s new plan is to continue paying distinct rates for each office/outpatient E/M code in 2021. The American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) have developed new guidelines for selecting E&M codes for office visits.
Levels are now determined by time spent both in direct and indirect patient care by physicians or technicians under the supervision of a physician, or complexity of Medical Decision Making (MDM.)
The level 1s, or “tech codes” have been deleted.
E&M Time MDM
99202 15-29 minutes Straightforward
99203 30-44 minutes Low
99204 45-59 minutes Moderate
99205 60-74 minutes High
99212 10-19 minutes Straightforward
99213 20-29 minutes Low
99214 30-39 minutes Moderate
99215 40-54 minutes High
Add-on codes include:
G0117 glaucoma screening by the doctor, high-risk patients
G0118 glaucoma screening under Dr. supervision, high-risk
Prolonged service codes
99358 additional hour of non-direct patient contact
99359 additional 30 mins of non-direct pt contact, w/99358
99415 additional hour of technician contact
99416 additional 30 mins of technician contact, w/99415
Members of the Professional Vision Group network are undergoing on-site training on the new coding and documentation guidelines for 2021.
Interested in on-site practice management and marketing services for privately-owned eye care practices? Drop us a note at email@example.com