This article is for all professional and outpatient facility providers
For 2021, the American Medical Association and the Centers for Medicare & Medicaid Services have released new CPT and HCPCS codes for prolonged evaluation and management (E/M) and visit complexity inherent to E/M.
Beginning January 1, 2021, we will reimburse for visit complexity inherent to the E/M service (HCPCS G2211) for Medicare Advantage products only.
|G2211||Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious, or complex chronic condition)|
Consistent with our existing payment policy, we will not reimburse the new prolonged E/M service codes 99417 and G2212 that are effective January 1, 2021.
|99417||Prolonged office or other outpatient evaluation and management service beyond the minimum required time of the primary procedure which has been selected using total time|
|G2212||Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact|
We notified you on September 1 that Blue Cross would adopt the 2021 American Medical Association new guidelines for outpatient evaluation and management code selection. As a reminder, professional RVU and fee updates will follow our normal update schedule:
To access this News Alert, log in and go to News. Look for the September 1 News Alert called "2021 evaluation and management guidelines update."
If you have any questions, call Network Management and Credentialing Services at 1-800-316-BLUE (2583). As always, thank you for the care you provide to our members.