BC Advantage - 2020 Issue 7

Medical Necessity, MDM, and 2021 E/M Changes

By now everyone has heard that we will no longer have to score history and exam components to determine an E&M code level for the office/outpatient CPT codes 99202-99215, beginning January 1, 2021. Instead, we will use new methods for determining the level of service based on either time or MDM.Let's take a step back and think about what is not changing: medical necessity.The term "medical necessity" does not appear in the AMA's CPT 2021 E&M changes document, so why do we care? Because the Social Security Act and the Medicare Claims Processing Manual...

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