E/M coding & guidelines

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E/M coding & guidelines

CMS and AMA educational resources to guide and educate on the E/M process:

AMA's 2021 changes to office and outpatient E/M services

AMA's 2023 changes to other E/M visits

AMA's Office Medical Decision Making (MDM) Table

CMS evaluation & management visits

CMS evaluation and management guide

CMS IOM Pub. 100-04, Chapter 12, Section 30.6 - E/M Service Codes

CMS FAQs: E/M visits

CMS FAQs: Split (or shared) visits and critical care services

Cognitive Assessment & Care Plan Services

G2211- E/M visit complexity add-on code:

MM13473- How to use office & outpatient E/M visit complexity add-on code G2211

MM13272- Edits to prevent payment of G2211 with office/outpatient E/M visit and modifier 25

CMS FAQS: HCPCS G2211

MM13004- Home or residence services: Billing instructions

Physician fee schedule (PFS) payment for office/outpatient E/M visits – Fact Sheet (PDF)

Signature guidelines:

MLN MM6698 - Signature guidelines for medical review purposes

MLN905364 – Complying with Medicare signature requirements

Interactive tools for E/M services

E/M interactive score sheet

E/M interactive score sheet updates: verify your E/M code selection in 2023

Incident-to tool

We fill in the gaps using educational resources to provide additional clarification:

Appealing new patient denials

Care management services

Critical care services

E/M services furnished by a non-physician practitioner incident to a physician's service

Incident-to

Observation services

Physician care plan oversight

Physician certification and recertification of home health services

Prolonged services:

Home or residence visits

Hospital inpatient or observation care services

Nursing facility E/M visits

Office and other outpatient E/M visits

Nursing facility E/M services

Sample signature attestation statement

Scribe services

Split (or shared) E/M

Teaching physicians

Telehealth services

E/M FAQs

Can't find what you were looking for? Here you will find the answers to the most frequently asked E/M questions.

For use with other E/M services prior to January 1, 2023

1995 Guidelines

1997 Guidelines

Printable score sheets

E/M 4 x 4 method

Additional coding references

American Academy of Professional Coders

American Medical Association

CMS Healthcare Common Procedure Coding System (HCPCS) coding questions

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Last modified: 01/21/2025

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