Major Overhaul Of E/M Codes Looming On The Horizon 2019

Last Updated:
Sep 27,
Major Overhaul Of E/M Codes Looming On The Horizon 2019

The proposal of a flat fee for all the E/M codes in the near future has ruffled some serious feathers with the CMS. The current system holds 5 different category levels demarcated by their respective pricing and procedures. The idea of collapsing Level 2 through to Level 5 for a flat fee has raised many eyebrows. It has also been stated that the likelihood of there being an Add-on payment of $67 per visit for spending more time with sicker patients is highly plausible sparing the case of emergency room visits.

The premise for this entire overhaul is likely to have risen from a need to reduce the physician’s burden; the time spent on leveling out of office’s visits and along the way eventually simplifying the complex process of selecting E/M codes.

The basis of selecting the codes will be MDM – Either Medical Decision Making or face time with the patient. The last major change implemented was the stoppage of reimbursement for consultation codes 99241 -99245 and 99251 – 99255). Along these lines, this will be the next big thing if it gets past the scrutiny by all stakeholders and if CMS manages to uphold all its virtues and stand its ground.

 New Patient  2018 rate, national avg  2019 rate, proposed national avg
 99201  $45  $44
 99202  $76  $135
 99203  $110  $135
 99204  $167  $135
 99205  $211  $135
 Established patient  2018 rate, national avg  2019 rate, proposed national avg
 99211  $22  $24
 99212  $45  $93
 99213  $74  $93
 99214  $109  $93
 99215  $148  $93

***First phase may start with 99201 to 99205 codes only.

Brace yourselves fellow Coders! An Overhaul is coming!!

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