Effective for dates of service on and after January 1, practitioners will have the choice to document office/outpatient evaluation and management (E/M) visits via medical decision making (MDM) or time. CMS is adopting the American Medical Association’s (AMA's) revised CPT guidance, including deletion of CPT code 99201. The E/M code and guideline changes are specific for office and other outpatient visits and apply to codes 99201–99205 and 99211–99215. Based on the CPT changes, code 99201 is no longer valid for dates of service on and after January 1, as clinicians may choose the E/M visit level based on either medical decision making or time; both CPT code 99201 and 99202 require straightforward medical decision making, therefore the decision was made to delete CPT code 99201.
To assist providers with this change, the E/M interactive worksheet (JH)(JL) has been updated. The updated worksheet will function based on the date of service and type of visit. If the date of service is on and after January 1, and related to an office or outpatient services visit, the worksheet options will align with the AMA guidance to determine the level of E/M service performed. If not related to office or outpatient services, or the date of service is prior to January 1, the worksheet options will remain based on the 1995 guidelines. Helpful resources and tips will be available within the tool as an added resource to guide providers in determining the level of E/M service.
Note: Effective for services on and after 01/01/2021, the 1995 and 1997 E/M guidelines for office/outpatient E/M visits is no longer used. Please refer to the AMA CPT E/M office visit revisions and the AMA table: CPT E/M Office Revisions - Medical Decision Making (MDM).
The score sheets are designed to assist only with identifying the appropriate level of service defined by the work documented as rendered using the CMS documentation guidelines for evaluation and management (E/M) services.
There is only one score sheet based on the 1995 guidelines which includes the three key components and time. This score sheet is referred to as the E/M (1995) score sheet. The 1997 guidelines were an enhancement to the 1995 guidelines to include status of chronic conditions, one general multisystem exam scorecard and 11 single organ system exam scorecards. The other components remained unchanged. These guidelines were developed by the American Medical Association (AMA), CMS, and various specialty societies. These guidelines focus only on the way the examination component is reviewed.
The score sheets must be used in conjunction with the CMS E/M guidelines for 1995 and 1997. Other factors must be considered before arriving at the final code reported to Medicare, including but not limited to, medical necessity and removing from the scoring any documented services reflective of separately reported preventive services and non-relevant documentation.
To view the complete guidelines published by CMS and the AMA, please refer to the following:
Note: Effective for services on and after 01/01/2021, the 1995 and 1997 E/M guidelines for office/outpatient E/M visits is no longer used. Please refer to the AMA CPT E/M office visit revisions and the AMA table: CPT E/M Office Revisions - Medical Decision Making (MDM).
For most cases, we recommend using the PDF format for printing or screen viewing. The HTML format is provided for special accessibility needs.
Note: To provide the highest quality scans on PDF versions, these sheets have been scanned at a high resolution. If you are printing hard copies of the PDF versions to your printer, be sure to select the "Shrink to Fit" option from Adobe Acrobat's Print screen for a clear, compressed copy.
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