The American Medical Association (AMA) announced the “first major overhaul in more than 25 years to the codes and guidelines for office and other outpatient evaluation and management (E/M) services” in its release of the 2021 Current Procedural Terminology (CPT®) code.

These foundational modifications were designed to make E/M office visit coding and documentation simpler and more flexible, according to the AMA. The changes to CPT codes ranging from 99201-99215 are proposed for adoption by the Centers for Medicare and Medicaid Services on January 1, 2021.

The E/M office visit modifications include:

  • Eliminating history and physical exam as elements for code selection.
  • Allowing physicians to choose the best patient care by permitting code level selection based on medical decision-making (MDM) or total time.
  • Promoting payer consistency with more detail added to CPT code descriptors and guidelines.


“To get the full benefit of the burden relief from the E/M office visit changes, health care organizations need to understand and be ready to use the revised CPT codes and guidelines by January 1, 2021,” said AMA President Susan R. Bailey, MD. “The AMA is helping physicians and healthcare organizations prepare now for the transition and offers authoritative resources to anticipate the operational, infrastructural, and administrative workflow adjustments that will result from the pending transition.”

The AMA has developed an extensive online resource library that includes a checklist, videos, modules, guidebooks, as well as other tools and resources to help transition to the revised E/M office visit codes and guidelines.

The revised E/M office visit codes are among 329 editorial changes in the 2021 CPT code set, including 206 new codes, 54 deletions, and 69 revisions. The CPT code set continues to see growth in new and novel areas of medicine, with the majority (63%) of new codes this year involving new technology services described in Category III CPT codes and the continued expansion of the Proprietary Laboratory Analyses (PLA) section of the CPT code set.

Changes to the CPT code set are considered through an open editorial process managed by the CPT Editorial Panel, an independent body convened by the AMA that collects broad input from the healthcare community and beyond to ensure CPT content reflects the coding demands of digital health, precision medicine, augmented intelligence, and other aspects of a modern healthcare system.

Among this year’s important additions to the CPT code set are new medical testing services sparked by the public health response to the COVID-19 pandemic. The CPT code set has been modified with several code additions and revisions that have been approved for immediate use and published for the 2021 CPT code set. 

The CPT code set continues to be modified to respond to the fast pace innovation among digital medicine services that can improve access to health care and improved health outcomes for patients across the country. This is illustrated by new codes for retinal imaging and external extended electrocardiogram (ECG) monitoring.

The addition of code 92229 for retinal imaging with automated point-of-care, and revision of codes 92227 and 92228, better support the screening of patients for diabetic retinopathy and increase early detection and incorporation of findings into diabetes care. Innovative solutions like the augmented intelligence technology described by new code 92229 have the potential to improve access for at-risk patient populations by bringing retinal imaging capabilities into the primary care setting.

Technological advances in the field of continuous cardiac monitoring and detection have prompted the addition of codes 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248, along with associated guideline revisions. These codes will replace Category III codes 0295T, 0296T, 0297T, and 0298T, which were deleted. These new codes utilize an innovative algorithmic technology that works in concert with a patch that is much easier to wear for patients and provides more accurate and complete data for physician interpretation.

To assist the healthcare system in an orderly annual transition to a newly modified CPT code set, the AMA releases each new edition four months ahead of the January 1 operational date and develops an insider’s view with detailed information on the new code changes.

The AMA also invites the healthcare community to stay up-to-date on the significant CPT code changes for 2021 by attending two virtual events this November, the Outpatient CDI Workshop and the CPT and RBRVS 2021 Annual Symposium. Meeting agendas and registration are available on the AMA website.

For more information, a special section for CPT education has been created for the AMA Ed Hub™, an online leaning platform containing CME and education, including a module series covering E/M codes, Clinical Examples of Radiology, as well as an overview of CPT coding basics.

Coding books and products, including the CPT 2021 Professional Codebook, are available from the AMA Store. The 2021 CPT codes and descriptors can be imported straight into existing claims and billing software using the downloadable CPT 2021 Data File. The file contains the updated code set’s complete descriptor package, including official descriptors for consumers and physicians, and the complete official CPT coding guidelines.

Source: AMA