CMS updates E/M billing, coding requirements — 5 key changes

CMS' final rule released Nov. 1 includes changes to the billing and coding requirements for evaluation and management services, Health Data Management reports.

Effective Jan. 1, CMS' E/M coding requirements will align with changes adopted by the American Medical Association CPT Editorial Panel for office and outpatient E/M visits.

The change, which is outlined in the new Medicare Physician Fee Schedule final rule, is intended to reduce clinician burnout, according to CMS Administrator Seema Verma.

"The Trump administration's final rule brings antiquated requirements, which are over 20 years old, up to date with the current practice of medicine and will impact the current and future generation of clinicians," she said.

CMS made the following key changes:

  • Reduced the number of levels for office and outpatient E/M visits for new patients
  • Revised the code definitions
  • Revised the times and medical decision-making process for all of the codes
  • Will only require performance of history and exam if medically appropriate
  • Will allow clinicians to choose the E/M visit level based on either time or medical decision-making

Click here to read more about the update.

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