Selection of Appropriate E/M Code during COVID-19 Public Health Emergency

On an interim basis, the Centers for Medicare and Medicaid Services (CMS) is revising its policy to specify that the office/outpatient E/M (Evaluation and Management) level selection for these services when furnished via telehealth can be based on MDM (Medical Decision Making) or time, with time defined as all of the time associated with the E/M on the day of the encounter; and to remove any requirements regarding documentation of history and/or physical exam in the medical record. This policy is similar to the policy that will apply to all office/outpatient E/Ms beginning in 2021 under policies finalized in the CY 2020 PFS final rule. It remains our expectation that practitioners will document E/M visits as necessary to ensure quality and continuity of care. To reduce the potential for confusion, we are maintaining the current definition of MDM. We note that currently there are typical times associated with the office/outpatient E/Ms, and we are finalizing those times as what should be met for purposes of level selection. The typical times associated with the office/outpatient E/Ms are available as a public use file. This policy only applies to office/outpatient visits furnished via Medicare telehealth, and only during the PHE for the COVID-19 pandemic.

CMS-1744-IFC 137

Federal Register, April 6, 2020.