Evaluation &

Management
Code Updates for 2024
EVALUATION AND MANAGEMENT ADDED/REVISED/DELETED CPT CODES DISCLAIMER

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2024 - Evaluation & Management Code changes overview
Three major changes that are set to go into effect Jan. 1, 2024:
1. Time ranges removed from office visit codes. The codes’ time ranges will be replaced with threshold times, which will bring them in
line with the rest of the level-based code.
2. Revised guidelines for split/shared visits. The changes will only apply to facility-based visits, The new guidelines will align with
Medicare’s current definition of substantive portion and address split/shared visits based on time and medical decision-making
(MDM).
3. More guidance for how to report same-day services and inpatient/observation services. The update will include a chart that
clarifies how to report inpatient and observation stays based on the length of the stay.

Split or shared visits

The CPT guidelines adopt the concept of calculating the substantive portion to determine which team member reports the visit.
If a practice codes a visit based on time, the practitioner who spends the majority of the face-to-face or non-face-to-face time on the date of
the encounter reports the service.
For example:
Physician A and Physician B are involved in the case. Physician A spent 40 minutes during encounter while physician B spent 10 minutes.
In this case service will be reported by physician A as majority of the time is spent by physician A

Multiple Evaluation and Management Services on the Same Date

The following guidelines apply to services that a patient may receive for hospital inpatient care, observation care, or nursing facility care.
The guidelines for multiple E/M services on the same date address circumstances in which the patient has received multiple visits or
services from the same physician or other QHP or another physician or other QHP of the exact same specialty and subspecialty who
belongs to the same group practice.
• Per day: When multiple visits occur over the course of a single calendar date in the same setting, a single service is reported.
• Multiple encounters in different settings or facilities: Can bill one E/M service for each setting or facility.

Discharge services
Discharge services and services in other facilities: Each service may be reported separately as long as any time spent on the discharge
service is not counted towards the total time of a subsequent service
Discharge services and services in the same facility: If the patient is discharged and readmitted to the same facility on the same calendar
date, report a subsequent care service instead of a discharge or initial service. For the purpose of E/M reporting, this is a single stay.
Discharge services and services in a different facility: Discharge and initial services may be reported as long as time spent on the
discharge service is not counted towards the total time of the subsequent service reported when code level selection is based on time.
Transitions between office or other outpatient, home or residence, or emergency department and hospital inpatient or observation
or nursing facility: When the patient is admitted to the hospital as an inpatient or to observation status in the course of an encounter in
another site of service (eg, hospital emergency department, office, nursing facility), the services in the initial site may be separately reported
by appending modifier 25.

Hospital inpatient or observation care services for 8-hour rule

Below guidelines are added for hospital inpatient or observation care services for 8-hour rule.

Length of Stay Discharged On Report Codes

<8 hours Same calendar date as initial hospital 99221, 99222, 99223
inpatient or observation care service
8 or more hours Same calendar date as initial hospital 99234, 99235, 99236
inpatient or observation care service
<8 hours Different calendar date as initial hospital 99221, 99222, 99223
inpatient or observation care service
8 or more hours Different calendar date as initial hospital 99221, 99222, 99223
inpatient or observation care service and 99238, 99239
Below are the 2024 CPT code updates for Evaluation & Management. This list includes new CPT codes, revised codes and deleted codes.

New and revised CPT Codes for 2024

Code Description

New codes
#+● 99459 Pelvic examination (List separately in addition to code for primary procedure)

Revised codes
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or
examination and straightforward medical decision making.
★▲ 99202
When using total time on the date of the encounter for code selection, 15-29 minutes of total time is spent on the date of the encounter minutes
must be met or exceeded.

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or
examination and low level of medical decision making.
★▲ 99203
When using total time on the date of the encounter for code selection, 30-44 minutes of total time is spent on the date of the encounter minutes
must be met or exceeded.

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or
examination and moderate medical decision making.
★▲ 99204
When using total time on the date of the encounter for code selection, 45-59 minutes of total time is spent on the date of the encounter minutes
must be met or exceeded.

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or
examination and high level of medical decision making.
★▲ 99205
When using total time on the date of the encounter for code selection, 60-74 minutes of total time is spent on the date of the encounter minutes
must be met or exceeded.

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or
examination and straightforward medical decision making.
★▲ 99212
When using total time on the date of the encounter for code selection, 10-19 minutes of total time is spent on the date of the encounter minutes
must be met or exceeded.

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or
examination and low level of medical decision making.
★▲ 99213
When using total time on the date of the encounter for code selection, 20-29 minutes of total time is spent on the date of the encounter minutes
must be met or exceeded.

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or
examination and moderate level of medical decision making.
★▲ 99214
When using total time on the date of the encounter for code selection, 30-39 minutes of total time is spent on the date of the encounter minutes
must be met or exceeded.

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or
examination and high level of medical decision making.
★▲ 99215
When using total time on the date of the encounter for code selection, 40-54 minutes of total time is spent on the date of the encounter minutes
must be met or exceeded.

Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or
examination and high level of medical decision making.
▲ 99306
When using total time on the date of the encounter for code selection, 4550 minutes must be met or exceeded.

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or
examination and low level of medical decision making.
★▲ 99308
When using total time on the date of the encounter for code selection, 1520 minutes must be met or exceeded.

● = New Code # = Resequenced code

▲ = Revised Code ★ = Telemed code
+ = Add on code

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