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:

Glaucoma       

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 info@professionalvisiongroup.com

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