Time and medical decision making levels for E/M CPT codes

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Office or other outpatient
Inpatient and observation care
Consultation
Emergency department
Nursing facility
Home or residence

Find the total time and medical decision making levels for a variety of E/M codes and service areas.

Learn which codes accurately reflect the complexity and length of a visit. Have questions about evaluation and management coding? See the full FAQ article.

Office or other outpatient services
CPT code	Patient type	MDM	Time (must be met or exceeded)
99202	New patient	Straightforward	15 minutes
99203	New patient	Low	30 minutes
99204	New patient	Moderate	45 minutes
99205	New patient	High	60 minutes
99212	Established patient	Straightforward	10 minutes
99213	Established patient	Low	20 minutes
99214	Established patient	Moderate	30 minutes
99215	Established patient	High	40 minutes
Prolonged services
+99417			75 minutes
G2212			89 minutes

Hospital inpatient and observation care services

CPT codes in this category are determined first by initial and subsequent care designations. This is determined based on whether the patient has received any professional services from the physician or other QHP or another physician or other QHP of the exact same specialty and subspecialty who belongs to the same group practice during the stay. This is like the new versus established patient definitions, except the determining factor is related to the stay rather than the past three years.

Hospital inpatient and observation care
CPT code	Visit type	MDM	Time (must be met or exceeded)
99221	Initial care	Straightforward or low	40 minutes
99222	Initial care	Moderate	55 minutes
99223	Initial care	High	75 minutes
+99418	Initial care, prolonged services	—	90 minutes or longer
G0316	Initial care, prolonged services	—	105 minutes or longer
99231	Subsequent care	Straightforward or low	25 minutes
99232	Subsequent care	Moderate	35 minutes
99233	Subsequent care	High	50 minutes
+99418	Subsequent care, prolonged services		65 minutes or longer
G0316	Subsequent care, prolonged services		80 minutes or longer

Hospital inpatient or discharge services (including admission and discharge services)
CPT code	MDM	Time (must be met or exceeded)
99234	Straightforward or low	45 minutes
99235	Moderate	70 minutes
99236	High	85 minutes
Prolonged services
+99418	—	100 minutes or longer
G0316	—	125 minutes or longer*

Hospital inpatient or observation discharge services
CPT code	Time
99238	30 minutes or less
99239	More than 30 minutes

Time includes total time on the date of the encounter. Hospital inpatient or observation care services require that the patient be admitted and discharged on the same date of service and the stay must be at least eight hours. Only the physician or QHP who performs both the initial and discharge service may report these services. When a patient receives hospital inpatient or observation care services for fewer than eight hours, use the initial hospital inpatient or observation care codes (CPT codes 99221-99223).

Consultation services
CPT code	Consultation type	MDM	Time (must be met or exceeded)
99241 (Deleted)	Office or outpatient	—	—
99242	Office or outpatient	Straightforward	20 minutes
99243	Office or outpatient	Low	30 minutes
99244	Office or outpatient	Moderate	40 minutes
99245	Office or outpatient	High	55 minutes
+99417	Office or outpatient, prolonged services	—	70 minutes or longer
99251 (Deleted)	Inpatient or observation	—	—
99252	Inpatient or observation	Straightforward	35 minutes
99253	Inpatient or observation	Low	45 minutes
99254	Inpatient or observation	Moderate	60 minutes
99255	Inpatient or observation	High	80 minutes
+99418	Inpatient or observation, prolonged services	—	95 minutes or longer

Emergency department services – new or established patient
CPT code	MDM
99282	Straightforward
99283	Low
99284	Moderate
99285	High
99281	—

MDM does not apply to 99281. CPT 99281 is intended for the E/M of a patient that may not require the presence of a physician or other QHP.

Initial nursing facility care – new or established patient
CPT code	MDM	Time (must be met or exceeded)
99304	Straightforward or low	25 minutes
99305	Moderate	35 minutes
99306	High	50 minutes
Prolonged services
+99418	—	60 minutes or longer
G0317	—	95 minutes or longer*

*Total time 1 day before visit + date of visit + 3 days after

Nursing facility discharge service
CPT code	Time (must be met or exceeded)
99315	30 minutes or less
99316	More than 30 minutes

Nursing facility discharge services require a face-to-face encounter with the patient and/or family/caregiver that may be performed on a date prior to the date the patient leaves the facility. The level of service should be selected based on the total time on the date of the face-to-face discharge management encounter.

The CPT code for annual nursing facility assessment (CPT code 99318) has been deleted. These services can be reported using the subsequent nursing facility care services (CPT codes 99307-99310) or Medicare G codes.

Subsequent nursing facility care – new or established patient
CPT code	MDM	Time (must be met or exceeded)
99307	Straightforward	10 minutes
99308	Low	20 minutes
99309	Moderate	30 minutes
99310	High	45 minutes
Prolonged services
+99418	—	60 minutes or longer
G0317	—	85 minutes or longer*

*Total time 1 day before visit + date of visit + 3 days after

The CPT Panel established a high-level MDM type specific to initial nursing facility care by the principal physician or other QHP that takes into account the number and complexity of problems addressed. This type is: "Multiple morbidities requiring intensive management: A set of conditions, syndromes or functional impairments that are likely to require frequent medication changes or other treatment changes and/or re-evaluations. The patient is at significant risk of worsening medical (including behavioral) status and risk for (re)admission to a hospital.”

A principal physician is sometimes referred to as the admitting physician and is the individual who oversees the patient’s care. This is different from other physicians or other QHPs who may be furnishing specialty care.

Initial versus subsequent is determined based on whether the patient has received any professional services from the physician or other QHP or another physician or other QHP of the exact same specialty and subspecialty who belongs to the same group practice during the stay. This is like the new versus established patient definitions, except the determining factor is related to the stay rather than the past three years.

Home or residence services
CPT code	Patient type	MDM	Time (must be met or exceeded)
99341	New patient	Straightforward	15 minutes
99342	New patient	Low	30 minutes
99343 (deleted)	—	—	—
99344	New patient	Moderate	60 minutes
99345	New patient	High	75 minutes
+99417	New patient, prolonged services	—	90 minutes or longer
G0318	New patient, prolonged services	—	141 minutes or longer*
99347	Established patient	Straightforward	20 minutes
99348	Established patient	Low	30 minutes
99349	Established patient	Moderate	40 minutes
99350	Established patient	High	60 minutes
+99417	Established patient, prolonged services	—	75 minutes or longer
G0318	Established patient, prolonged services	—	112 minutes or longer*

*Total time 3 days before visit + date of visit + 7 days after

The domiciliary or rest home CPT codes (99334-99340) have been deleted and merged with the existing home visit CPT codes (99341-99350).

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Time and medical decision making levels for E/M CPT codes

Office or other outpatient services

Hospital inpatient and observation care services

Consultation services

Emergency department services

Nursing facility services

Home or residence services

Time and medical decision making levels for E/M CPT codes

Office or other outpatient services

Hospital inpatient and observation care services

Consultation services

Emergency department services

Nursing facility services

Home or residence services

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