Evaluation & Management: Anticipated Changes for Office and Outpatient Services in 2021

“Pending confirmation in the upcoming Centers for Medicare & Medicaid (CMS) 2021 Final Rule, National Government Services (NGS) is reminding Part B providers of expected changes to Evaluation & Management (E/M) guidelines for office and outpatient services. These include services in the CPT code range of 99202-99215 (CPT 99201 is expected to be eliminated).

These expected changes will impact office and outpatient E/M information currently posted on our website; impacted materials are currently undergoing review and pending revision.

The expected changes will apply particularly to the E/M Review Tool currently used by NGS medical review and available as a provider reference. Once CMS confirms the expected changes, this tool will no longer apply to office and outpatient services, but may still be used as a reference for scoring inpatient E/M services. No tool will be developed for scoring office and outpatient services, since these will be based on time and/or the level of medically necessary MDM documented by the provider.

NGS will be offering educational sessions on all anticipated changes, once they are confirmed by CMS in the 2021 Final Rule. Updated information on all aspects of office and outpatient E/M services will be available on the NGS website in advance of the expected effectuation date of 1/1/2021.”

CLICK HERE to view the current E/M tool.

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