Evaluation and Management CPT Codes: Medical Billing Reference
Complete reference for E/M CPT codes. Covers outpatient, inpatient, and telehealth E/M codes, 2024 documentation guidelines, and correct level selection.
Billing EVALUATION.MANAGEMENT Correctly
Complete reference for E/M CPT codes. Covers outpatient, inpatient, and telehealth E/M codes, 2024 documentation guidelines, and correct level selection.
Source: AAPC Codify - CPT® 2025
EVALUATION-MANAGEMENT in Detail
What does EVALUATION-MANAGEMENT cover in detail?
Evaluation and management codes (99202–99215 and hospital equivalents) are the most frequently audited CPT codes because level selection directly affects revenue and compliance.
Append modifier 25 when a significant E/M is provided the same day as a procedure, and reference the CPT codes hub alongside our medical coding services for complete code guidance.
Using EVALUATION-MANAGEMENT Correctly
How do I use EVALUATION-MANAGEMENT correctly?
Documentation Requirements
Ensure clinical notes clearly support the level of service, procedure performed, and medical necessity for this CPT code.
Modifier Requirements
Determine whether any modifiers are required for this code, particularly in bilateral, assistant surgeon, or multiple procedure scenarios.
Payer-Specific Rules
Check payer fee schedules and coverage policies, as reimbursement and coverage rules for this code vary by payer.
Bundling Considerations
Review NCCI edits to confirm this code is not bundled with other procedures billed on the same date of service.
Common Evaluation and Management CPT Codes
| CPT Code | Description | MDM Level | Time Threshold |
|---|---|---|---|
| 99202 | New patient - office/outpatient E/M visit | Straightforward | 15+ minutes |
| 99203 | New patient - office/outpatient E/M visit | Low | 30+ minutes |
| 99204 | New patient - office/outpatient E/M visit | Moderate | 45+ minutes |
| 99205 | New patient - office/outpatient E/M visit | High | 60+ minutes |
| 99211 | Established patient - may not require physician presence | N/A | No minimum |
| 99212 | Established patient - office/outpatient E/M visit | Straightforward | 10+ minutes |
| 99213 | Established patient - office/outpatient E/M visit | Low | 20+ minutes |
| 99214 | Established patient - office/outpatient E/M visit | Moderate | 30+ minutes |
| 99215 | Established patient - office/outpatient E/M visit | High | 40+ minutes |
| 99283 | Emergency department E/M visit | Low | N/A |
Source: AAPC Codify - CPT® 2025
EVALUATION-MANAGEMENT, Frequently Asked Questions
Evaluation and management codes (99202–99215 and hospital equivalents) are the most frequently audited CPT codes because level selection directly affects revenue and compliance.
Append modifier 25 when a significant E/M is provided the same day as a procedure, and reference the CPT codes hub alongside our medical coding services for complete code guidance.
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