As discussed in “Office and Other Outpatient Evaluation and Management: Big Changes May Be Coming,” the Centers for Medicare & Medicaid Services (CMS) and the Current Procedural Terminology (CPT®) Editorial Panel are considering changes to coding of office and other outpatient evaluation and management (E/M) services starting January 1, 2021. This article provides examples of what the CMS has proposed. However, there is potential for pending CPT changes to override what the CMS has proposed.

CMS proposals includes Healthcare Common Procedure Coding System (HCPCS) add-on codes that may apply when reporting office and other outpatient E/M codes 99202–99204 and 99212–99214. The HCPCS codes would not be appended to code 99205 or 99215.

Pediatricians providing primary care services would report code GPC1X in addition to all E/M services reported with codes 99202–99204 and 99212–99214 to reflect that each E/M service was provided in the context of...

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