What is time-based billing for E/M services?

Time-based billing allows code selection based on total time spent on the date of encounter rather than MDM complexity. Under 2021 guidelines, total time includes all physician time on the calendar day: pre-visit preparation, face-to-face time, and post-visit documentation and coordination.

What activities count toward total time for E/M billing?

Countable activities include: reviewing tests and records, obtaining/reviewing history, performing examination, counseling and education, ordering tests and referrals, prescribing medications, documenting in the record, communicating with other providers, and care coordination. Travel time and time spent by clinical staff do not count.

When should I use time-based billing instead of MDM?

Use time-based billing when: counseling and coordination exceed typical MDM activities, extensive pre-visit preparation is required, complex care coordination with multiple providers occurs, or when total time spent exceeds the time threshold for a higher code than MDM would support.

What are the time thresholds for office E/M codes?

New patients: 99202 (15-29 min), 99203 (30-44 min), 99204 (45-59 min), 99205 (60-74 min). Established patients: 99212 (10-19 min), 99213 (20-29 min), 99214 (30-39 min), 99215 (40-54 min). Time beyond these thresholds may qualify for prolonged services.

How do I document time-based billing?

Document total time spent: 'Total time on date of encounter: [X] minutes.' Optionally describe time breakdown (recommended): pre-visit review, face-to-face examination and counseling, and post-visit documentation and coordination. Time documentation must be specific, not vague estimates.

Time-Based Billing Documentation Template

Administrative All Specialties Updated: 11/26/2025

The Time-Based Billing Documentation Template helps physicians accurately document total time for E/M code selection based on time thresholds rather than medical decision making complexity. This guide covers the 2021 E/M guidelines allowing time-based billing for office visits, prolonged services add-on codes, care coordination time, and proper documentation format. Includes time thresholds for each CPT code level (99202-99215), what activities count toward total time, and template language for compliant documentation.

Time-Based Billing Documentation Guide

What Counts as Total Time?

Included Activities

Preparing to see patient (chart review)
Obtaining history
Performing examination
Counseling and education
Ordering and reviewing tests
Referring and communicating
Documenting
Care coordination

NOT Included

Clinical staff time
Travel time
Teaching time
Time on different calendar day

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Time Thresholds

New Patient

Code	Time
99202	15-29 min
99203	30-44 min
99204	45-59 min
99205	60-74 min

Established Patient

Code	Time
99212	10-19 min
99213	20-29 min
99214	30-39 min
99215	40-54 min

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Prolonged Services (99417)

Add to 99205 or 99215 when time exceeds threshold:

Established: Start at 55 minutes
New: Start at 75 minutes
Bill per additional 15-minute increment

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Documentation Template

```
TIME DOCUMENTATION
Total time on date of encounter: [X] minutes
Activities included:

Pre-visit preparation: [X] minutes
Face-to-face with patient: [X] minutes
Post-visit documentation/coordination: [X] minutes

Based on total time of [X] minutes, this visit supports
[code level].
```
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When to Use Time-Based Billing

1. Counseling-heavy visits
2. Complex care coordination
3. Extensive pre-visit planning
4. Documentation-intensive visits
Compare MDM vs time and bill the higher supported code.