Jan 12, 2021

Major Update to CPT Codes for 2021

Helen Farnen  |  Updated June 28


Using the most accurate Current Procedural Terminology® (CPT) codes is one of the best ways to avoid claim rejections and get reimbursed faster. In the third quarter of 2020, the American Medical Association (AMA) released new codes, the first major revision of office visit and outpatient evaluation and management (E/M) codes in 25 years. And, with the approval of COVID-19 vaccines, the AMA has released codes for administering the vaccines. The goal: make it easier for clinicians to document services and reduce administrative tasks.

Here’s what you need to know about the 2021 codes:

  • Changes to CPT codes are proposed for adoption by the Centers for Medicare and Medicaid Services (CMS) to take effect on January 2, 2021
  • There are more than 206 new codes, 54 deletions, and 69 revisions
  • New codes include testing services and technologies related to COVID-19, including vaccines; as of December 21, 2020, the following codes apply:
    • Category I code 91300 for the Pfizer-BioNTech vaccine, codes 0001A and 0002A for administration of the first and second doses, respectively 
    • Category I code 91301 for the Moderna vaccine, codes 0011A and 0012A for the first and second doses, respectively
    • As other vaccines receive FDA approval, expect the AMA to assign codes for these vaccines 
  • Patient codes for new patients 99201-99205 require three key components be met: history, exam, and medical decision-making (MDM); patient codes 99211-99215 for established patients required only two of the three components be satisfied
  • The revised codes…
    • Take into account the additional time, effort, and relative value units (RVUs) required for new patients versus established patients
    • Eliminate history and physical exams as elements for code selection and allow physicians to select the code levels based on MDM or total time
  • Proposed remote patient monitoring (RPM) codes may reverse Coronavirus rules allowing telehealth for new patients to cover only established patients once the COVID-19 public health emergency has passed
    • RPMs may require a minimum 20-minute interactive virtual visit
    • The proposed codes cover acute conditions, as well as chronic conditions 
  • New codes have been added for digital medicine innovations, such as retinal imaging and external extended electrocardiogram monitoring
  • Updated codes help promote better consistency in payments from payers by adding more details to CPT code descriptors and guidelines

For more information, read the AMA press releases about the 2021 CPT codes and new COVID-19 vaccine codes.

RXNT simplifies how you code your services

RXNT’s Electronic Health Records (EHR) and Practice Management software is updated with new CPT codes, including those for 2021, when they become available. In addition, our products include “Quick Pick” features that allow you to customize encounters for codes you use frequently. And for those procedures you don’t perform regularly, the robust Search feature helps you find codes quickly. Click here for a no-risk, no-obligation demonstration of RXNT’s coding workflows that will help your practice increase efficiency and stay up to date.

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