Tracking down all the CPT codes for 2021 can be time consuming and overwhelming. No more! We’ve done the grunt work for you and compiled a simplified, need-to know code list for the coming year.
The new CPT codes for 2021 reflect a spirit of simplicity: modifications were made in an effort to remove irrelevant administrative burdens that have led to time-wasting tasks in the past.
In that same spirit of bringing greater simplicity to the often overwhelming world of CPT codes, we’ve streamlined this post for 2021. Exhibit A: no need to scroll to the CPT codes category you need. Just click on any link in this list of new CPT codes, and jump ahead to the sections that best apply to your practice.
- Evaluation and Management
- Prolonged Services
- Medicare Telehealth
- Pathology & Laboratory
- COVID-19 Testing
Reminders & Updates for 2021
Before you jump into the codes, a quick reminder: with the New Year come many insurance changes. So when patients arrive, be sure to
- Verify their insurance
- Note any changes to their policies
- Collect the deductible
In 2021, Medicare will have a decrease by almost 10% in the conversion factor—as well as lower reimbursements.
The deductible for part B has increased $5, from $198 to $203.
List of New CPT Codes for 2021
While our CPT code list is not exhaustive, it is thorough, simple to navigate, and easy to understand. Our goal: make information on CPT codes accessible and clear, so that you can implement and share any changes quickly and effectively.
The CPT codes for 2021 represent the American Medical Association‘s (AMA) first major overhaul to outpatient evaluation and management codes in over 25 years. The AMA has provided a document that goes into more detail regarding outpatient and prolonged service code changes.
The overhaul is focused on outpatient visits, while inpatient codes remain the same. Doctors can now determine which code to use based on either the medical decision made or the time required. This allows the provider different methods by which to determine the code level.
There are 329 editorial changes, which include
- 206 new codes
- 54 deletions
- 69 revisions
Some of these 2021 changes are due to the public health response to the COVID-19 pandemic, and some would have happened regardless.
Whatever your speciality, there are many CPT code changes to process, and we’re here to help guide you through it. So don’t hesitate to contact us with any quesitons.
Evaluation & Management
The evaluation and management category has a number of CPT code changes for 2021. The changes were made in an effort to respond to the fast pace of innovation among digital-medicine services.
The biggest change: the provider who decides what levels of history and exam are required for treatment.
Let’s get started:
99202 – 99205
Office or other outpatient visit for the evaluation and management of a new patient; 99201 has been deleted
The physician or qualified health care professional spends time supervising the clinical staff performing the face-to-face service
99212 – 99215
Office or other outpatient visit for the evaluation and management of an established patient
99281 – 99285
For services provided in the emergency department
99217 – 99226
For observation care
99234 – 99236
99354 – 99357
Prolonged service with direct patient contact provided beyond usual service in inpatient, observation, or outpatient setting
99358 – 99359
Prolonged service without direct patient contact
Prolonged evaluation and management service provided in office or outpatient with physician or other qualified health care professional supervision
A number of Medicare telehealth services have been added to the list of new CPT codes for 2021. Category 3 refers to services that have been added due to the COVID-19 pandemic and will remain on the list until the pandemic ceases.
96121 (96130-96133, 96136 – 96139 category 3 basis)
Psychological and Neuropsychological testing
99334 – 99335 (99336 – 99337 category 3 basis)
Domiciliary, rest home, or custodial care services with established patients
99347 – 99348 (99349 – 99350 category 3 basis)
Home visits with established patients
99281 – 99285 category 3 basis
Emergency Department Visits, levels 1-5
99315-99316 category 3
Nursing facilities discharge day management
97161-97168, 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521-92524, 92507 category 3
Therapy services, physical and occupational therapy, all levels
99238-99239 category 3
Hospital discharge day management
99469, 99472,99476 category 3
Subsequent inpatient neonatal and pediatric critical care
99478-99480 category 3
Continuing neonatal intensive care services
99291-99292 category 3
Critical care services
90952, 90953, 90956, 90959, 90962 category 3
End-stage renal disease monthly capitation payment codes
99217, 99224-99226 category 3
Subsequent observation and observation discharge day management
Cognitive assessment and care planning services
Visit complexity inherent to certain office/outpatient evaluation and management
Surgery CPT Codes for 2021
Surgery: Breast Repair & Reconstruction
19316 – 19323, 19325-19365, 19367-19396
Revised to provide a clearer description of different breast repair & reconstruction techniques, 19324 and 19366 were deleted
Replacement of breast tissue expander with permanent implant
29822 – 29823
Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s)
33741, 33745, 33746
Shunting procedure for congenital cardiac anomalies
Revised to specify procedure involves the left heart
Insertion of ventricular assist device in the right heart
Removal of the ventricular assist device from the left heart
Transrectal ablation of malignant prostate tissue using HIFU
Surgery: Nervous System
64455, 64479, 64480, 64483, 64484
71250, 71260, 71270
Revised to include “diagnostic”
Added to report low-dose thorax computed tomography (CT) for lung cancer screening
Revised for clarity, removed “pyelogram, nephrostogram, loopogram”
Pathology & Laboratory
Several new codes were added to the Therapeutic Drug Assays subsection:
- 80143 Acetaminophen
- 80151 Amiodarone
- 80161 -10, 11- epoxide
- 80167 Felbamate
- 80181 Flecainide
- 80189 Itraconzole
- 80193 Leflunomide
- 80204 Methotrexate
- 80210 Rufinamide
- 80179 Salicylate
81168, 81278, and 81279
Medicine CPT Codes for 2021
Rabies immune globin code to report heat- and solvent/ detergent-treated human doses, administered intramuscularly
92227 – 92229
Retinal imaging for detection or monitoring of diseases
93241 – 93248
COVID-19 CPT Codes for 2021
In response to the need to report COVID-19 testing, many of the new codes went into effect in 2020.
Single-step immunoassay antibody detection
Multiple-step immunoassay antibody detection
Infectious agent detection with nucleic acid probe
Report pathogen detection
Revised to add “fluorescence immunoassay” and to delete “multiple-step method”
87636, 87637, 87811
Distinguish the tests for influenza A, influenza B, and RSV that include SRS-CoV-2 from those that don’t
CPT Codes for 2021 : Conclusion
In this post, we took the less-is-more approach. If you would like more information on one of the listed changes, don’t hesitate to contact us. We’re more than happy to answer your questions.