On January 1, 2021, significant changes to the office and outpatient Evaluation and Management (E&M) services Current Procedural Terminology (CPT®) codes (99202-99215) will go into effect. Practices, physicians, and staff must prepare in advance for these changes to ensure a successful transition and avoid any disruption in reimbursement.
ASCO has prepared a set of tools and is continuing to develop educational materials that explain the coming changes. ASCO started by identifying nine essential tips to help oncology practices ensure they’re prepared for the change.
In addition to an overview of all the changes, ASCO is developing tip sheets with guidance on specific changes. The first three are available now:
Selecting a Code Based on Medical Decision-Making in 2021: Medical decision-making is currently part of the E&M selection components. However, changes have been made to the key elements of medical decision-making and the criteria for selection.
2021 Evaluation and Management Changes: Selecting a Code Based on Time: Starting January 1, providers may select the level of office and outpatient E&M services based on either time or medical decision-making. In 2021, the definition of time will be based on the total time (face-to-face and non–face-to-face) spent by a provider on the day of the encounter. The current time-related rule requiring 50% of the visit be spent on counseling and/or coordination of care to report the service based on time will no longer be applicable.
2021 Evaluation and Management Changes: New Prolonged Services Code: Also starting January 1, a new prolonged services CPT® code will available. The code reflects a “prolonged office or other E&M service that requires at least 15 minutes or more of total time either with OR without direct patient contact on the date of the primary E&M service (either CPT® codes 99205 or 99215).
Visit asco.org/ascoaction and ASCO Practice Central to stay up-to-date as more resources become available. Questions regarding the changes can be sent to ASCO staff at billingandcoding@asco.org.
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