Data Updated for Q4 2018
CPT Code: 99204
Description: Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family.
Status Code
A
Active Code. These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an “A” indicator does not mean that Medicare has made a nation
Global Days
XXX
The global concept does not apply to the code.
Medicare RUVs and Fees
Work RVU – 2.43
Malpractice RVU – 0.22
Facility RVU – 1.01
Non-Facility RVU – 2.00
Facility Total RVU – 3.66
Non-Facility Total RVU – 4.65
Medicare National Facility Total Payment – $131.76
Medicare National Non-Facility Total Payment – $167.4
Bundling Information
Includes
0074T, 0115T, 0116T, 0359T, 0360T, 0361T, 0362T, 0363T, 0364T, 0365T, 0366T, 0367T, 0368T, 0369T, 0370T, 0371T, 0372T, 0373T, 0374T, 0469T, 36591, 36592, 43752, 78730, 80500, 80502, 81002, 81025, 82044, 83013, 83014, 83019, 84525, 90862, 90863, 90940, 92002, 92004, 92012, 92014, 92227, 92228, 92531, 92532, 93561, 93562, 93562, 93792, 93793, 94002, 94003, 94004, 94656, 94657, 94660, 94660, 94662, 94662, 95831, 95832, 95833, 95834, 95851, 95852, 96020, 96101, 96102, 96103, 96105, 96115, 96116, 96118, 96119, 96120, 96125, 96150, 96151, 96152, 96153, 96154, 96155, 96523, 97802, 97803, 97804, 99172, 99173, 99174, 99177, 99201, 99202, 99203, 99211, 99212, 99213, 99214, 99215, 99408, 99409, 99446, 99447, 99448, 99449, 99605, 99606, G0101, G0102, G0104, G0105, G0106, G0107, G0117, G0118, G0120, G0245, G0246, G0248, G0250, G0270, G0271, G0272, G0363, G0396, G0397, G0442, G0443, G0444, G0445, G0446, G0447, G0459, G0473, M0064, P3000, P3001, Q0091
Included In
00100, 00102, 00103, 00104, 00120, 00124, 00126, 00140, 00142, 00144, 00145, 00147, 00148, 00160, 00162, 00164, 00170, 00172, 00174, 00176, 00190, 00192, 00210, 00211, 00212, 00214, 00215, 00216, 00218, 00220, 00222, 00300, 00320, 00322, 00326, 00350, 00352, 00400, 00402, 00404, 00406, 00410, 00420, 00450, 00452, 00454, 00470, 00472, 00474, 00500, 00520, 00522, 00524, 00528, 00529, 00530, 00532, 00534, 00537, 00539, 00540, 00541, 00542, 00544, 00546, 00548, 00550, 00560, 00561, 00562, 00563, 00566, 00567, 00580, 00600, 00604, 00620, 00622, 00625, 00626, 00630, 00632, 00634, 00635, 00640, 00670, 00700, 00702, 00730, 00731, 00732, 0073T, 00740, 00750, 00752, 00754, 00756, 00770, 00790, 00792, 00794, 00796, 00797, 00800, 00802, 00810, 00811, 00812, 00813, 00820, 0082T, 00830, 00832, 00834, 00836, 0083T, 00840, 00842, 00844, 00846, 00848, 00850, 00851, 00855, 00857, 00860, 00862, 00864, 00865, 00866, 00868, 00869, 00870, 00872, 00873, 00880, 00882, 00884, 00900, 00902, 00904, 00906, 00908, 00910, 00912, 00914, 00916, 00918, 00920, 00921, 00922, 00924, 00926, 00928, 00930, 00932, 00934, 00936, 00938, 00940, 00942, 00944, 00946, 00948, 00950, 00952, 00955, 01000, 01110, 01112, 01120, 01130, 01140, 01150, 01160, 01170, 01173, 01180, 01190, 01200, 01202, 01210, 01212, 01214, 01215, 01220, 01230, 01232, 01234, 01240, 01250, 01260, 01270, 01272, 01274, 01300, 01320, 01340, 01360, 01380, 01382, 01390, 01392, 01400, 01402, 01404, 01420, 01430, 01432, 01440, 01442, 01444, 01460, 01462, 01464, 01470, 01472, 01474, 01480, 01482, 01484, 01486, 01490, 01500, 01502, 01520, 01522, 01600, 01610, 01620, 01622, 01630, 01632, 01634, 01636, 01638, 01650, 01652, 01654, 01656, 01670, 01680, 01682, 01700, 01710, 01712, 01714, 01716, 01730, 01732, 01740, 01742, 01744, 01756, 01758, 01760, 01770, 01772, 01780, 01782, 01784, 01800, 01810, 01820, 01829, 01830, 01832, 01840, 01842, 01844, 01850, 01852, 01860, 01905, 01916, 01920, 01922, 01924, 01925, 01926, 01930, 01931, 01932, 01933, 01935, 01936, 01951, 01952, 01958, 01960, 01961, 01962, 01963, 01964, 01965, 01966, 01967, 01968, 01969, 0197T, 01990, 01991, 01992, 0394T, 0395T, 11720, 11721, 11976, 15824, 15825, 15826, 15828, 15829, 15876, 15877, 15878, 15879, 17380, 32850, 33930, 33940, 33960, 33975, 33976, 36000, 36010, 36011, 36012, 36013, 36014, 36015, 36100, 36120, 36140, 36145, 36160, 36200, 36215, 36216, 36217, 36245, 36246, 36247, 36410, 36420, 36425, 36430, 36440, 36450, 36455, 36460, 36468, 36469, 36511, 36512, 36513, 36514, 36515, 36516, 36550, 36600, 36823, 37195, 37211, 37212, 37213, 37214, 38120, 38206, 38240, 38241, 41820, 41821, 41850, 41870, 47133, 47134, 48550, 50300, 59050, 59051, 59400, 59410, 59425, 59426, 59430, 59510, 59515, 59610, 59614, 59618, 59622, 61645, 61793, 62367, 62368, 70010, 70015, 70170, 70332, 70336, 70371, 70373, 70390, 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 70540, 70541, 70551, 70552, 70553, 71036, 71040, 71060, 71090, 71250, 71260, 71270, 71550, 71555, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72192, 72193, 72194, 72196, 72240, 72255, 72265, 72270, 72275, 72285, 72295, 73040, 73085, 73115, 73200, 73201, 73202, 73220, 73221, 73525, 73542, 73580, 73615, 73700, 73701, 73702, 73720, 73721, 73725, 74150, 74160, 74170, 74181, 74185, 74190, 74230, 74235, 74260, 74283, 74290, 74291, 74300, 74305, 74320, 74327, 74328, 74329, 74330, 74340, 74350, 74355, 74360, 74363, 74400, 74410, 74415, 74420, 74425, 74430, 74440, 74445, 74450, 74455, 74470, 74475, 74480, 74485, 74740, 74742, 75552, 75553, 75554, 75555, 75600, 75605, 75625, 75630, 75650, 75658, 75660, 75662, 75665, 75671, 75676, 75680, 75685, 75705, 75710, 75716, 75722, 75724, 75726, 75731, 75733, 75736, 75741, 75743, 75746, 75756, 75774, 75790, 75801, 75803, 75805, 75807, 75809, 75810, 75820, 75822, 75825, 75827, 75831, 75833, 75840, 75842, 75860, 75870, 75872, 75880, 75885, 75887, 75889, 75891, 75893, 75894, 75896, 75898, 75900, 75940, 75945, 75960, 75961, 75962, 75966, 75970, 75978, 75980, 75982, 75984, 75989, 75992, 75994, 75995, 76000, 76001, 76003, 76005, 76006, 76075, 76076, 76078, 76086, 76088, 76090, 76091, 76092, 76093, 76094, 76095, 76096, 76120, 76125, 76355, 76360, 76365, 76370, 76375, 76380, 76390, 76400, 76506, 76511, 76512, 76513, 76516, 76519, 76529, 76536, 76604, 76645, 76700, 76705, 76770, 76775, 76778, 76800, 76805, 76810, 76815, 76816, 76818, 76825, 76826, 76827, 76828, 76830, 76831, 76856, 76857, 76870, 76872, 76873, 76880, 76885, 76886, 76930, 76932, 76934, 76936, 76938, 76941, 76942, 76945, 76946, 76948, 76950, 76960, 76965, 76970, 76975, 76977, 76986, 77261, 77262, 77263, 77280, 77285, 77290, 77293, 77295, 77300, 77301, 77305, 77306, 77307, 77310, 77315, 77316, 77317, 77318, 77321, 77326, 77327, 77328, 77331, 77332, 77333, 77334, 77336, 77338, 77370, 77371, 77372, 77373, 77401, 77402, 77403, 77404, 77406, 77407, 77408, 77409, 77411, 77412, 77413, 77414, 77416, 77417, 77418, 77419, 77420, 77421, 77422, 77423, 77424, 77425, 77425, 77427, 77430, 77431, 77432, 77435, 77469, 77470, 77520, 77522, 77523, 77525, 77600, 77605, 77610, 77615, 77620, 77750, 77761, 77762, 77763, 77767, 77768, 77776, 77777, 77778, 77781, 77782, 77783, 77784, 77785, 77786, 77787, 77789, 77790, 78000, 78001, 78003, 78006, 78007, 78010, 78011, 78015, 78016, 78018, 78070, 78075, 78102, 78103, 78104, 78110, 78111, 78120, 78121, 78122, 78130, 78135, 78140, 78160, 78162, 78170, 78172, 78185, 78190, 78191, 78195, 78201, 78202, 78205, 78206, 78215, 78216, 78220, 78223, 78230, 78231, 78232, 78258, 78261, 78262, 78264, 78267, 78270, 78271, 78272, 78278, 78282, 78290, 78291, 78300, 78305, 78306, 78315, 78320, 78350, 78414, 78428, 78445, 78455, 78456, 78457, 78458, 78460, 78461, 78464, 78465, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78494, 78580, 78584, 78585, 78586, 78587, 78588, 78591, 78593, 78594, 78596, 78600, 78601, 78605, 78606, 78607, 78610, 78615, 78630, 78635, 78645, 78647, 78650, 78660, 78700, 78701, 78704, 78707, 78708, 78709, 78710, 78715, 78725, 78730, 78740, 78760, 78761, 78800, 78801, 78802, 78803, 78805, 78806, 78807, 79000, 79001, 79020, 79030, 79035, 79100, 79200, 79300, 79400, 79420, 79440, 80400, 80402, 80406, 80408, 80410, 80412, 80414, 80415, 80416, 80417, 80418, 80420, 80422, 80424, 80426, 80428, 80430, 80432, 80434, 80435, 80436, 80438, 80439, 80440, 82953, 83014, 84620, 85095, 85102, 86077, 86078, 86079, 86890, 86891, 86950, 87164, 87166, 88170, 88171, 88329, 88331, 88332, 89100, 89105, 89130, 89132, 89135, 89136, 89140, 89141, 89190, 89350, 89360, 89365, 90460, 90461, 90471, 90472, 90473, 90474, 90760, 90765, 90769, 90772, 90773, 90774, 90780, 90781, 90783, 90788, 90791, 90792, 90801, 90802, 90805, 90807, 90809, 90811, 90813, 90815, 90817, 90819, 90820, 90822, 90824, 90827, 90829, 90832, 90834, 90837, 90842, 90843, 90844, 90845, 90846, 90847, 90847, 90849, 90849, 90853, 90853, 90855, 90857, 90857, 90865, 90865, 90867, 90868, 90869, 90875, 90880, 90880, 90918, 90919, 90920, 90921, 90922, 90923, 90924, 90925, 90935, 90937, 90945, 90947, 90951, 90952, 90953, 90954, 90955, 90956, 90957, 90958, 90959, 90960, 90961, 90962, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 90989, 90993, 92311, 92312, 92313, 92315, 92316, 92317, 92325, 92326, 92330, 92335, 92502, 92504, 92506, 92507, 92508, 92510, 92511, 92512, 92516, 92520, 92525, 92526, 92541, 92542, 92543, 92544, 92545, 92546, 92548, 92552, 92553, 92555, 92556, 92557, 92561, 92562, 92563, 92564, 92565, 92567, 92568, 92569, 92571, 92572, 92573, 92575, 92576, 92577, 92579, 92582, 92583, 92584, 92585, 92587, 92588, 92589, 92597, 92598, 93012, 93014, 93015, 93015, 93016, 93016, 93017, 93017, 93018, 93018, 93024, 93224, 93225, 93226, 93227, 93230, 93231, 93232, 93233, 93235, 93236, 93237, 93268, 93270, 93271, 93272, 93278, 93303, 93304, 93307, 93308, 93312, 93313, 93314, 93315, 93316, 93317, 93350, 93555, 93556, 93720, 93721, 93727, 93731, 93732, 93733, 93734, 93735, 93736, 93737, 93738, 93741, 93742, 93743, 93744, 93875, 93880, 93882, 93886, 93888, 93922, 93923, 93924, 93925, 93926, 93930, 93931, 93965, 93970, 93971, 93975, 93976, 93978, 93979, 93980, 93981, 93990, 94010, 94011, 94012, 94013, 94014, 94014, 94015, 94015, 94016, 94060, 94070, 94070, 94150, 94200, 94250, 94375, 94400, 94450, 94452, 94453, 94610, 94617, 94618, 94620, 94620, 94621, 94621, 94640, 94640, 94642, 94642, 94644, 94645, 94650, 94651, 94652, 94660, 94660, 94662, 94662, 94664, 94664, 94665, 94667, 94667, 94668, 94668, 94669, 94680, 94681, 94690, 94726, 94727, 94728, 94729, 94750, 94760, 94761, 94762, 94770, 94772, 94774, 94775, 94776, 94777, 94780, 94781, 95004, 95004, 95010, 95010, 95012, 95015, 95015, 95017, 95018, 95024, 95024, 95027, 95027, 95028, 95028, 95044, 95044, 95052, 95052, 95056, 95056, 95060, 95060, 95065, 95065, 95070, 95070, 95071, 95071, 95075, 95075, 95076, 95078, 95079, 95115, 95117, 95120, 95125, 95130, 95131, 95132, 95133, 95134, 95144, 95145, 95146, 95147, 95148, 95149, 95165, 95170, 95180, 95805, 95806, 95807, 95808, 95810, 95811, 95812, 95813, 95816, 95819, 95822, 95824, 95827, 95829, 95830, 95950, 95951, 95953, 95954, 95955, 95956, 95957, 95958, 95961, 95970, 95971, 95972, 95974, 96100, 96105, 96110, 96111, 96111, 96115, 96117, 96360, 96365, 96369, 96372, 96373, 96374, 96377, 96400, 96401, 96402, 96405, 96406, 96408, 96409, 96410, 96413, 96414, 96416, 96420, 96422, 96425, 96440, 96445, 96446, 96450, 96520, 96521, 96522, 96530, 96542, 96542, 96900, 96910, 96912, 96913, 97001, 97002, 97012, 97014, 97016, 97018, 97020, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97110, 97112, 97113, 97116, 97124, 97139, 97140, 97150, 97504, 97520, 97530, 97535, 97537, 97542, 97545, 97703, 97750, 97770, 97810, 97811, 97813, 97814, 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 98943, 99143, 99144, 99148, 99149, 99151, 99152, 99155, 99156, 99183, 99183, 99185, 99186, 99190, 99191, 99192, 99195, 99205, 99218, 99219, 99220, 99221, 99222, 99223, 99224, 99225, 99226, 99234, 99235, 99236, 99238, 99239, 99293, 99294, 99295, 99296, 99298, 99299, 99300, 99304, 99305, 99306, 99455, 99456, 99466, 99468, 99469, 99471, 99472, 99475, 99476, 99477, 99478, 99479, 99480, 99483, 99485, 99486, C8950, C8952, C8953, C8954, C8956, C8957, C9273, G0008, G0009, G0010, G0030, G0031, G0032, G0033, G0034, G0035, G0036, G0037, G0038, G0039, G0040, G0041, G0042, G0043, G0044, G0045, G0046, G0047, G0072, G0074, G0076, G0078, G0080, G0082, G0084, G0086, G0088, G0090, G0092, G0094, G0101, G0104, G0105, G0106, G0108, G0109, G0110, G0111, G0112, G0113, G0114, G0115, G0116, G0120, G0121, G0125, G0126, G0128, G0129, G0130, G0131, G0132, G0151, G0152, G0153, G0154, G0155, G0156, G0159, G0161, G0163, G0164, G0165, G0166, G0169, G0172, G0173, G0242, G0243, G0251, G0302, G0303, G0304, G0305, G0308, G0309, G0310, G0311, G0312, G0313, G0314, G0315, G0316, G0317, G0318, G0319, G0320, G0321, G0322, G0323, G0324, G0325, G0326, G0327, G0338, G0339, G0340, G0345, G0347, G0351, G0353, G0355, G0356, G0357, G0359, G0361, G0410, G0411, G0463, G0491, G0492, G0498, G0500, G0505, G6002, G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014, G6015, G6016, G6017, M0064, M0302, P3000, P3001, Q0091, Q0091, Q2043
Mutually Exclusive
11719, 90806, 90808, 90810, 90812, 90814, 90816, 90818, 90821, 90823, 90826, 90828, 90846, 92002, 92004, 92012, 92014, 97001, 97002, 97003, 97003, 97004, 97004, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, G0127, G0337, G0344, G0402, G0438, G0439
If you get stuck finding the right Code, take a look at our 5 Ways to Find the Most Appropriate CPT Code.
Related CPT Codes
CPT Code | Description |
---|---|
99201 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. |
99201 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. |
99202 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family. |
99203 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family. |
99204 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. |
99205 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family. |
99211 | Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services. |
99212 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. |
99213 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, 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 of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family. |
99214 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family. |
99215 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family. |
99217 | Observation care discharge day management (This code is to be utilized to report all services provided to a patient on discharge from outpatient hospital “observation status” if the discharge is on other than the initial date of “observation status.” To report services to a patient designated as “observation status” or “inpatient status” and discharged on the same date, use the codes for Observation or Inpatient Care Services [including Admission and Discharge Services, 99234-99236 as appropriate.]) |
99218 | Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the problem(s) requiring admission to outpatient hospital “observation status” are of low severity. Typically, 30 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99219 | Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the problem(s) requiring admission to outpatient hospital “observation status” are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99220 | Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the problem(s) requiring admission to outpatient hospital “observation status” are of high severity. Typically, 70 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99221 | Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the problem(s) requiring admission are of low severity. Typically, 30 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99222 | Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the problem(s) requiring admission are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99223 | Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the problem(s) requiring admission are of high severity. Typically, 70 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99224 | Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is stable, recovering, or improving. Typically, 15 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99225 | Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99226 | Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Typically, 35 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99231 | Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is stable, recovering or improving. Typically, 15 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99232 | Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99233 | Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Typically, 35 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99234 | Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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) requiring admission are of low severity. Typically, 40 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99235 | Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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) requiring admission are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99236 | Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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) requiring admission are of high severity. Typically, 55 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99238 | Hospital discharge day management; 30 minutes or less |
99239 | Hospital discharge day management; more than 30 minutes |
99241 | Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family. |
99242 | Office consultation for a new or established patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of low severity. Typically, 30 minutes are spent face-to-face with the patient and/or family. |
99243 | Office consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of moderate severity. Typically, 40 minutes are spent face-to-face with the patient and/or family. |
99244 | Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family. |
99245 | Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of moderate to high severity. Typically, 80 minutes are spent face-to-face with the patient and/or family. |
99251 | Inpatient consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 self limited or minor. Typically, 20 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99252 | Inpatient consultation for a new or established patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of low severity. Typically, 40 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99253 | Inpatient consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of moderate severity. Typically, 55 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99254 | Inpatient consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of moderate to high severity. Typically, 80 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99255 | Inpatient consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of moderate to high severity. Typically, 110 minutes are spent at the bedside and on the patient’s hospital floor or unit. |
99281 | Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 self limited or minor. |
99282 | Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of low to moderate severity. |
99283 | Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of moderate severity. |
99284 | Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of high severity, and require urgent evaluation by the physician, or other qualified health care professionals but do not pose an immediate significant threat to life or physiologic function. |
99285 | Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient’s clinical condition and/or mental status: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, 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 of high severity and pose an immediate significant threat to life or physiologic function. |
99288 | Physician or other qualified health care professional direction of emergency medical systems (EMS) emergency care, advanced life support |
99291 | Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes |
99292 | Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service) |