Code categories for E/M services in hospital settings may describe services in terms of whether the encounter is an initial or subsequent encounter. Terms such as initial and subsequent encounter might appear simple, but selecting the correct code category isn’t always straightforward.

All references to physicians in this article are inclusive of other qualified health care professionals (QHPs) who independently provide and report E/M services.

The CPT code categories used to report initial and subsequent E/M services are listed in the Table. Relative value units (RVUs) are included to illustrate the differences in assigned values for initial and subsequent services. Denial or overpayment might result if you incorrectly report a code for an initial encounter when a subsequent encounter code is appropriate. Please consult your CPT manual or other resource for code descriptors with required key components and typical unit/floor times (when applicable).

All E/M services provided on the...

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