eTable 1.
Elements Needed for Visit CPT Code
| Visit type, CPT code | History |
Examination | MDM | Total encounter time, min | ||
|---|---|---|---|---|---|---|
| HPI | ROS | FSH | ||||
| Outpatient consultation∗ | ||||||
| 99241 | 1 | NA | NA | 1 OS | SF | 15 |
| 99242 | 1 | 1 | NA | 2–7 OS | SF | 30 |
| 99243 | 4 | 2 | 1 | D | Low | 40 |
| 99244 | 4 | 10+ | 3 | 8 OS | Moderate | 60 |
| 99245 | 4 | 10+ | 3 | 8 OS | High | 80 |
| New patient visit∗ | ||||||
| 99201 | 1 | NA | NA | 1 OS | SF | 10 |
| 99202 | 1 | 1 | NA | 2–7 OS | SF | 20 |
| 99203 | 4 | 2 | 1 | D | Low | 30 |
| 99204 | 4 | 10+ | 3 | 8 OS | Moderate | 45 |
| 99205 | 4 | 10+ | 3 | 8 OS | High | 60 |
| Established patient visit† | ||||||
| 99211 | NA | NA | NA | NA | NA | 5 |
| 99212 | 1 | NA | NA | 1 OS | SF | 10 |
| 99213 | 1 | 1 | NA | 2–7 OS | Low | 15 |
| 99214 | 4 | 2 | 1 | D | Moderate | 25 |
| 99215 | 4 | 10+ | 2 of 3 | 8 OS | High | 40 |
D, detailed examination (requires at least 2 findings for at least 2 organ systems/body areas); FSH, family and social history; HPI, history of present illness; MDM, medical decision making; NA, not applicable; OS, organ system; ROS, review of systems; SF, straightforward.
∗
Must address 3 of 3 history/examination/MDM.
†
Must address 2 of 3 history/examination/MDM.