New or Established Patient. It is important to note that an initial service may be reported when the patient has not received any professional services from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice during the stay.

• 99221 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low-level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
• 99222 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.
• 99223 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.
• For services of 90 minutes or longer, use prolonged services code 993X0.

• 99231 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.
• 99232 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.
• 99233 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.
• For services of 65 minutes or longer, use prolonged services code 993X0.

• 99234 Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
• 99235 Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 70 minutes must be met or exceeded.
• 99236 Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 85 minutes must be met or exceeded.
• For services of 100 minutes or longer, use prolonged services code 993X0.

• 99238 Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter.
• 99239 more than 30 minutes on the date of the encounter.
• For hospital inpatient or observation care including the admission and discharge of the patient on the same date, see 99234, 99235, 99236.

• 99252 Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.
• 99253 Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
• 99254 Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
• 99255 Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 80 minutes must be met or exceeded.
• For services 95 minutes or longer, use prolonged services code 993X0.

Time is not a descriptive component for the emergency department levels of E/M services because emergency department services are typically provided on a variable intensity basis, often involving multiple encounters with several patients over an extended period of time. There is no distinction made between new and established patients in the emergency department. E/M services in the emergency department may be reported for any new or established patient who presents for treatment in the emergency department.

• 99281 Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional.
• 99282 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making.
• 99283 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making.
• 99284 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.
• 99285 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making.

The following codes are used to report Evaluation and Management Services to patients in nursing facilities and skilled nursing facilities. These codes should also be used to report evaluation and management services provided to a patient in a psychiatric residential treatment center and immediate care facility for individuals with intellectual disabilities.

Initial Nursing Facility Care, New or Established Patient:

• 99304 Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.
• 99305 Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.
• 99306 Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
• For services 60 minutes or longer, use prolonged services code 993X0.
  
  

Nursing Facility Services, Subsequent Nursing Facility Care:

• 99307 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
• 99308 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
• 99309 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
• 99310 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
• For services 60 minutes or longer, use prolonged services code 993X0.

• Deletion of Domiciliary, rest Home (eg Boarding Home), or Custodial Care Services E/M codes 99324-99328, 99334-99337, 99339, 99340.
• Deletion of Home or residence Services E/M code 99343.
• Revision of Home or Residence Services E/M codes 99341, 99342, 99344, 99345, 99347-99350 and guidelines.
• The following codes are used to report evaluation and management services provided in a home or residence. Home may be defined as a private residence, temporary lodging, or short-term accommodation (eg, hotel, campground, hostel, or cruise ship).
• These codes are also used when the residence is an assisted living facility, group home (that is not licensed as an intermediate care facility for individuals with intellectual disabilities), custodial care facility, or residential substance abuse treatment facility.

• 99341 Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straight forward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
• 99342 Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
• 99343 has been deleted. To report, see 99341, 99342, 99344, 99345.
• 99344 Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
• 99345 Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.
• For services 90 minutes or longer, see prolonged services code 99417.

• 99347 Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
• 99348 Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
• 99349 Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
• 99350 Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
• For services 75 minutes or longer, see prolonged services code 99417.

• 99354, 99355 have been deleted. For prolonged evaluation and management services on the date of an outpatient service, home or residence service, or cognitive assessment and care plan, use 99417.
• 99356, 99357 have been deleted. For prolonged evaluation and management services on the date of an inpatient or observation or nursing facility service, use 993X0.

DELETED
CPT 1580 – Removal of sutures under anesthesia (other than local), same surgeon

REVISED
CPT 15851 – Removal of sutures under anesthesia (other than local), other surgeon
As of January 1, 2023: CPT 15851 – Removal of sutures or staples requiring anesthesia (i.e., general anesthesia, moderate sedation)

New CPT Code
CPT 15853 – Removal of sutures or staples not requiring anesthesia (list separately in addition to E/M code)
(Use 15853 in conjunction with 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350)

New CPT Code
CPT 15854 – Removal of sutures and staples not requiring anesthesia (list separately in addition to E/M code)
(Use 15854 in conjunction with 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350)

New CPT Language
CPT 20816 – Replantation, digit, excluding thumb (includes metacarpophalangeal joint of flexor sublimis tendon), complete amputation
COT 20822 – Replantation, digit, excluding thumb (includes distal tip to sublimis tendon insertion), complete amputation
CPT 20838 – Replantation, foot, complete amputation

No longer effective as of January 1, 2023:
(To report replantation of incomplete amputation, see specific code[s] for repair of bone[s], ligament[s], tendon[s], nerve[s], or blood vessels with modifier 52)

Effective January 1, 2023:
(For repair of incomplete amputation report the specific code[s] for repair of bone[s] ligament[s], tendon[s], nerve[s], or blood vessels and append modifier 51 or 59 as appropriate)
For replantation of complete amputation of the lower extremity, except foot, report the specific code[s} for repair of of bone[s] ligament[s], tendon[s], nerve[s], or blood vessels and append modifier 51 or 59 as appropriate)

New CPT Language
“Imaging guidance and localization may be reported separately for 64400, 64405, 64408, 64420, 64421, 64425, 64430, 64435, 64449, 64450.”

Revised
CPT 76882 – Ultrasound, limited, joint or other nonvascular extremity structure(s) (eg. joint space, periarticular tendon[s], muscle[s], nerve[s], or other soft-tissue structure[s], or soft-tissue mass[es]), real-time with image documentation
As of January 1, 2023: CPT 76882 – Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) ((eg. joint space, periarticular tendon[s], muscle[s], nerve[s], or other soft-tissue structure[s], or soft-tissue mass[es]), real-time with image documentation

New CPT code
CPT 76883 – Ultrasound, nerve(s) and accompanying structures throughout their entire anatomic course in one extremity, comprehensive, including real-time cine imaging with image documentation, per extremity.

New CPT Language
“Comprehensive evaluation of a nerve is defined as evaluation of the nerve throughout its course in an extremity. Documentation of the entire course of a nerve throughout an extremity includes the acquisition and permanent archive of cine clips and static images to demonstrate the anatomy.”

New CPT Codes
CPT 0737T Xenograft implantation into the articular surface
CPT 0766T Transcutaneous magnetic stimulation by focused low frequency electromagnetic pulse, peripheral nerve, initial treatment, with identification and marking of the treatment location, including noninvasive electroneurographic localization (nerve conduction localization), when performed; first nerve
CPT 0767T each additional nerve (list separately in addition to code for primary procedure)

Deleted CPT codes
CPT 0491T Ablative laser treatment. Non-contact, full shield and fractional ablation, open wound, per day, total treatment surface area; first 20 sq cm or less
CPT 0492T each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure)

CPT 0493T Contact near – infrared spectroscopy studies of lower extremity wounds (e.g., for oxyhemoglobin measurement)