May 21, 2020

CMS Publishes Revised Medicare E/M Guidelines

The Centers for Medicare & Medicaid Services (CMS) recently released revised Medicare Evaluation and Management (E/M) Medicare Learning Network (MLN) guidelines, mainly covering requirements for documentation, coding and billing.

As reported in the CMS MLN Booklet, CMS is aligning E/M coding with changes adopted by the American Medical Association Current Procedural Terminology Editorial Panel for office/outpatient E/M visits as of Jan. 1, 2021.

The revised policy specifically retains five levels of coding for established patients, reduces the number of levels to four for office/outpatient E/M visits for new patients and revises the code definitions.

The policy revises the times and medical decision-making process for all of the codes and requires performance of history and exam only as medically appropriate. It allows clinicians to choose the E/M visit level based on either medical decision making or time.

In addition, CMS plans to implement the revised payment rates for office/outpatient E/M services and moves forward with the add-on code, GPC1X.

Questions about these revisions may be directed via email to the American College of Radiology® Economics and Health Policy staff.