New E/M, COVID-19 Codes Will Take Effect Jan. 1, 2021

This month, the American Medical Association (AMA) published the 2021 Current Procedural Terminology (CPT®) code set, 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. These codes will take effect Jan. 1, 2021. 
In 2019, the Centers for Medicare and Medicaid Services (CMS) finalized changes to CPT codes 99201-99215, which are designed to make E/M office visit coding and documentation simpler and more flexible. The changes are largely responsible for the proposed cut of nearly 11 percent to the Medicare conversion factor that will be required next year to maintain Medicare budget neutrality. 

While cardiologists will experience a proposed 1 percent Medicare fee schedule increase on average next year, the impact will vary by a physician's mix of services, with those who provide diagnostic imaging services more negatively affected.

The AMA has developed an 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.
New COVID-19 Test Codes
Also added to the 2021 CPT code set are two new medical testing services sparked by the public health response to the COVID-19 pandemic.
  • CPT code 99072 allows for the provision of evaluation, treatment, or procedural services during a public health emergency in a setting where extra precautions are taken to ensure the safety of patients as well as healthcare professionals.
  • CPT code 86413 was approved in response to the development of laboratory tests that provide quantitative measurements of SARS-CoV-2 antibodies, as opposed to a qualitative assessment (positive/negative) of SAR-CoV-2 antibodies provided by laboratory tests reported by other CPT codes.
These codes have been approved for immediate use. Contact third-party payers regarding reimbursement policies and reporting guidelines for these codes.
More information about these codes can found in the latest
CPT Assistant