Evaluation & Management (E&M) CPT Codes
Office visits, hospital services, consultations, and preventive care
Overview
E&M codes are the most frequently used CPT codes, covering office visits, hospital services, consultations, and preventive care. Accurate coding requires understanding time-based and medical decision-making (MDM) criteria.
Most Common Evaluation & Management (E&M) CPT Codes
Top 30 frequently used codes in this specialty
Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes
Critical Care
Initial hospital care, per day, typically 70 minutes
Hospital Inpatient Services
Office or other outpatient visit, new patient, level 5
Office Visits
Initial preventive medicine, age 65 years and older, new patient
Preventive Medicine Services
Office or other outpatient visit, established patient, level 5
Office Visits
Initial preventive medicine, age 40-64 years, new patient
Preventive Medicine Services
Initial hospital care, per day, typically 50 minutes
Hospital Inpatient Services
Office or other outpatient visit, new patient, level 4
Office Visits
Initial preventive medicine, age 18-39 years, new patient
Preventive Medicine Services
Initial preventive medicine, age 65 years and older, established patient
Preventive Medicine Services
Complex chronic care management services, first 60 minutes
Care Management Services
Annual Wellness Visit, initial
Preventive Medicine
Initial preventive medicine, age 40-64 years, established patient
Preventive Medicine Services
Subsequent hospital care, per day, typically 50 minutes
Hospital Inpatient Services
Office or other outpatient visit, established patient, level 4
Office Visits
Annual Wellness Visit, subsequent
Preventive Medicine
Initial preventive medicine, age 18-39 years, established patient
Preventive Medicine Services
Office or other outpatient visit, new patient, level 3
Office Visits
Initial hospital care, per day, typically 30 minutes
Hospital Inpatient Services
Subsequent hospital care, per day, typically 35 minutes
Hospital Inpatient Services
Hospital discharge day management, 30 minutes or less
Hospital Inpatient Services
Initial comprehensive preventive medicine, age <1 year
Preventive Medicine
Office or other outpatient visit, established patient, level 3
Office Visits
Periodic comprehensive preventive medicine, established patient, age <1 year
Preventive Medicine
Office or other outpatient visit, new patient, level 2
Office Visits
Complex chronic care management services, each additional 30 minutes
Care Management Services
Subsequent hospital care, per day, typically 25 minutes
Hospital Inpatient Services
Office or other outpatient visit, established patient, level 2
Office Visits
Remote physiologic monitoring treatment management, first 20 minutes
Care Management Services
Chronic care management services, each additional 20 minutes (add-on)
Care Management Services
Browse by Subcategory
Explore codes organized by procedure type
Hospital Inpatient Services
7 codes
- 99223 Initial hospital care, per day, typically 70 minutes
- 99222 Initial hospital care, per day, typically 50 minutes
- 99233 Subsequent hospital care, per day, typically 50 minutes
- 99221 Initial hospital care, per day, typically 30 minutes
- 99232 Subsequent hospital care, per day, typically 35 minutes
Office Visits
9 codes
- 99205 Office or other outpatient visit, new patient, level 5
- 99215 Office or other outpatient visit, established patient, level 5
- 99204 Office or other outpatient visit, new patient, level 4
- 99214 Office or other outpatient visit, established patient, level 4
- 99203 Office or other outpatient visit, new patient, level 3
Preventive Medicine Services
6 codes
- 99394 Initial preventive medicine, age 65 years and older, new patient
- 99393 Initial preventive medicine, age 40-64 years, new patient
- 99392 Initial preventive medicine, age 18-39 years, new patient
- 99384 Initial preventive medicine, age 65 years and older, established patient
- 99383 Initial preventive medicine, age 40-64 years, established patient
Care Management Services
4 codes
Documentation Tips
- Document total time for time-based coding
- Support MDM level with 2 of 3 components
- Distinguish preventive from diagnostic services
- Document same-day procedure relationship
- Include chief complaint and HPI for all visits
Common Denial Patterns
Understanding common denial reasons helps prevent claim rejections and improves audit defense.
- Upcoding - insufficient documentation for complexity
- Time documentation missing or incorrect
- MDM level not supported by documentation
- Same-day E&M bundled incorrectly
- Preventive vs. diagnostic services confused
Frequently Asked Questions
Select either total time on the date of service or MDM, whichever is most appropriate and best supported.
Include total time and activities (review, exam, counseling, coordination). Avoid double‑counting across services.
Bill both when significant and separately identifiable; document distinct problems and apply modifier 25 to the E&M.
Insufficient documentation for MDM or time. Ensure chief complaint, HPI, assessment, plan, and medical necessity are clear.
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