Medicaid Billing CPT Codes: Medical Evaluation



Medicaid Billing CPT Codes: Medical Evaluation

|CPT CODE |DESCRIPTION |SPECIAL RULES |SESSION TIME/UNITS |

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|99201 | | | |

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|99201 |OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF NEW PATIENT, | | |

| |WHICH REQUIRES THESE 3 KEY COMPONENTS: A PROBLEM FOCUSED HISTORY; A PROBLEM | | |

| |FOCUSED EXAMINATION; STRAIGHT FORWARD MEDICAL DECISION MAKING. COUNSELING | | |

| |AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR AGENCIES ARE PROVIDED |For practitioner services other E&M codes (e.g., 99201-99215) are | |

| |CONSISTENT WITH THE NATURE OF THE PROBLEMS) AND THE |not separately reportable with individual psychotherapy codes |Approximately 10 minutes |

| |PATIENT'S AND/OR FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEM[S) ARE SELF |(90804-90829) on the same date of service. | |

| |LIMITED OR MINOR. PHYSICIANS TYPICALLY SPEND 10 MINUTES FACE-TO-FACE WITH THE | | |

| |PATIENT AND/OR FAMILY. | | |

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| |OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF NEW PATIENT, | | |

| |WHICH REQUIRES THESE 3 KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY; AN| | |

| |EXPANDED PROBLEM FOCUSED EXAMINATION; STRAIGHT FORWARD MEDICAL DECISION |For practitioner services other E&M codes (e.g., 99201-99215) are | |

| |MAKING. COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR |not separately reportable with individual psychotherapy codes | |

|99202 |AGENCIES ARE PROVIDED ONSISTENT WITH THE NATURE OF THE PROBLEM(S) AND THE |(90804-90829) on the same date of service. |Approximately 20 minutes |

| |PATIENTS AND/OR FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEM(S) ARE LOW TO | | |

| |MODERATE | | |

| |SEVERITY. PHYSICIANS TYPICALLY SPEND 20 MINUTES FAOE-TO-FACE WITH THE PATIENT | | |

| |AND/OR FAMILY. | | |

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| |OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF NEW PATIENT, | | |

| |WHICH REQUIRES THESE 3 KEY COMPONENTS: A DETAILED HISTORY; A DETAILED |For practitioner services other E&M codes (e.g., 99201- 9215) are | |

| |EXAMINATION; MEDICAL DECISION MAKING OF LOW COMPLEXITY. COUNSELING AND/OR |not separately reportable with individual psychotherapy codes | |

|99203 |COORDINATION OF CARE WITH OTHER PROVIDERS OR AGENCIES ARE PROVIDED CONSISTENT |(90804-90829) on the same date of service. | |

| |WITH THE NATURE OF THE PROBLEM(S) AND THE PATIENTS AND/OR FAMILY'S NEEDS. | |Approximately 30 minutes |

| |USUALLY, THE PRESENTING PROBLEM(S) ARE OF MODERATE SEVERITY. PHYSICIANS | | |

| |TYPICALLY SPEND 30 MINUTES FACE-TO-FACE WITH THE PATIENT AND/OR FAMILY. | | |

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| |OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF NEW PATIENT, | | |

| |WHICH REQUIRES THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY; A |For practitioner services other E&M codes (e.g., 99201-99215) are | |

| |COMPREHENSIVE EXAMINATION MEDICAL DECISION MAKING OF MODERATE COMPLEXITY. |not separately reportable with Individual psychotherapy codes | |

| |COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR AGENCIES ARE |(90804-90829) on the same date of service. | |

| |PROVIDED CONSISTENT WITH THE NATURE OF THE PROBLEM(S) AND THE PATIENTS AND/OR | | |

| |FAMILY'S NEEDS. USUAUY, THE PRESENTING | | |

| |PROBLEMS(S) ARE MODERATE TO HIGH SEVERITY. PHYSICIANS | | |

| |TYPICALLY SPEND 45 MINUTES FACE-TO-FACE WITH THE PATIENT AND/OR FAMILY. | | |

| | | |Approximately 45 minutes |

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|99204 | | | |

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Medicaid Billing CPT Codes: Medical Evaluation

|CPT CODE |DESCRIPTION |SPECIAL RULES |SESSION TIME/UNITS |

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| | | | |

| | | | |

| | | | |

|99201 | | | |

| | | | |

| | | | |

| | | | |

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| |OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF NEW PATIENT, | | |

|99205 |WHICH REQUIRES THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY; A |For practitioner services other E&M codes (e.g., 99201-99215) are | |

| |COMPREHENSIVE EXAMINATION; MEDICAL DECISION MAKING OF HIGH COMPLEXITY. |not separately reportable with Individual psychotherapy codes |Approximately 60 minutes |

| |COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR AGENCIES ARE |(90804-90829) on the same date of service. | |

| |PROVIDED CONSISTENT WITH THE NATURE OF THE PROBLEM(S) AND THE PATIENTS AND/OR| | |

| |FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEMS) ARE MODERATE TO HIGH | | |

| |SEVERITY. PHYSICIANS TYPICALLY SPEND 60 MINUTES FACE-TO-FACE WITH THE PATIENT| | |

| |AND/OR FAMILY. | | |

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| |OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF AN |For practitioner services other E&M codes (e.g., 99201-99215) are |Approximately 5 minutes |

| |ESTABLISHED PATIENT, THAT MAY NOT REQUIRE THE PRESENCE OF A PHYSICIAN,. |not separately reportable with Individual psychotherapy codes | |

|99211 |USUALLY THE PRESENTING PROBLEMS) ARE MINIMAL. TYPICALLY, 5 MINUTES ARE SPENT |(90804-90829) on the same date of service. | |

| |PERFORMI NG OR SUPERVISING THESE | | |

| |SERVICES. | | |

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| | |For practitioner services other E&M codes (e.g., 99201- 9215) are | |

| |OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF |not separately reportable with individual psychotherapy codes | |

|99212 |AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY |(90804-90829) on the same date of service |Approximately 10 minutes |

| |COMPONENTS: A PROBLEM FOCUSED HISTORY; A PROBLEM FOCUSED | | |

| |EXAMINATION; STRAIGHT FORWARD MEDICAL DECISION MAKING. |. | |

| |COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS | | |

| |OR AGENCIES ARE PROVIDED CONSISTENT WITH THE NATURE OF THE | | |

| |PROBLEM(S) AND THE PATIENTS AND/OR FAMILY'S NEEDS. USUALLY, THE | | |

| |PRESENTING PROBLEM(S) ARE SELF LMITED OR MINOR. PHYSICIANS | | |

| |TYPICALLY SPEND 10 MINUTES FACE-TO-FACE WITH THE PATIENT AND/OR | | |

| |FAMILY. | | |

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|99213 |OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF |For practitioner services other E&M codes (e.g., 99201-99215) are |Approximately 15 minutes |

| |AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY |not separately reportable with Individual psychotherapy codes | |

| |COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY; AN |(90804-90829) on the same date of service. | |

| |I-XPANDED PROBLEM FOCUSED EXAMINATION; MEDICAL DECISION | | |

| |MAKING OF LOW COMPLEXITY. COUNSELING AND/OR COORDINATION OF | | |

| |CARE WITH OTHER PROVIDERS OR AGENCIES ARE PROVIDED CONSISTENT | | |

| |WITH THE NATURE OF THE PROBLEM(S) AND THE PATIENTS AND/OR | | |

| |FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEM(S) ARE LOW TO | | |

| |MODERATE SEVERITY. PHYSICIANS TYPICALLY SPEND IS MINUTES FACE-TO | | |

| |FACE WITH THE PATIENT AND/OR FAMILY | | |

|Page 2 of 3 |

| Medicaid Billing CPT Codes: Medical Evaluation |

| |DESCRIPTION |SPECIAL RULES |SESSION TIME/UNITS |

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|99214 | | | |

| |OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MGMT OF AN | | |

| |ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: A |For practitioner services other E&M codes (e.g., 99201-99215) are | |

| |DETAILED HISTORY; A DETAILED EXAMINATION; |not separately reportable with Individual psychotherapy codes |Approximately 25 minutes |

| |MEDICAL DECISION MAKING OF MODERATE COMPLEXITY. COUNSELING |(90804-90829) on the same date of service. | |

| |AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR AGENCIES ARE PROVIDED | | |

| |CONSISTENT WITH THE NATURE OF THE PROBLEM(S) AND THE PATIENT'S AND/OR | | |

| |FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEM(S) ARE MODERATE TO HIGH | | |

| |SEVERITY. PHYSICIANS TYPICALLY SPEND 25 MINUTES FACE-TO-FACE WITH THE PATIENT| | |

| |AND/OR FAMILY. | | |

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| |OFFICE OR OTHER OUTPATIENT VISIT POR THE EVALUATION AND MGMT Of AN |For practitioner services other E&M codes (e.g., 99201-99215) are | |

| |ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: A |not separately reportable with Individual psychotherapy codes | |

|99215 |COMPREHENSIVE HISTORY; A COMPREHENSIVE |(90804-90829) on the same date of service. |Approximately 40 minutes |

| |EXAMINATION; MEDICAL DECISION MAKING OF HIGH COMPLEXITY. | | |

| |COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR AGENCIES ARE | | |

| |PROVIDED CONSISTENT WITH THE NATURE OF THE PROBLEM(5) AND THE PATIENTS AND/OR| | |

| |FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEM(S) ARE MODERATE TO HIGH | | |

| |SEVERITY. PHYSICIANS TYPICALLY SPEND 40 MINUTES FACE-TO-FACE WITH THE PATIENT| | |

| |AND/OR PAMILY. | | |

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