CPT Codes for 2021, Simplified + E&M Documentation Updates

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.

CPT codes for 2021 represented by stethoscope pen medical formThe 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.

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

99211

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

For observation or inpatient care services, including admission and discharge services

Prolonged Services

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

99415, 99416

Prolonged evaluation and management service provided in office or outpatient with physician or other qualified health care professional supervision

99XXX

Prolonged office or other outpatient evaluation and management service(s), use in conjunction with 99205 and 99215

Medicare Telehealth

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.

90853

Group psychotherapy

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

99483

Cognitive assessment and care planning services

G2211

Visit complexity inherent to certain office/outpatient evaluation and management

G2212

Prolonged services

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

11970

Replacement of breast tissue expander with permanent implant

11971

Removal of breast tissue expander without insertion of implant

Surgery: Endoscopy/Arthroscopy

29822 – 29823

Define the difference between limited versus extensive debridement

Surgery: Respiratory

30468

Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s)

32405 deleted
32408

Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance when performed

Surgery: Cardiovascular

33741, 33745, 33746

Shunting procedure for congenital cardiac anomalies

33900, 33991

Revised to specify procedure involves the left heart

33995

Insertion of ventricular assist device in the right heart

33992

Removal of the ventricular assist device from the left heart

33997

Removal of a ventricular assist device from the right heart

Surgery: Genitals

55880

Transrectal ablation of malignant prostate tissue using HIFU

+57465

Computer-aided mapping of abnormal areas of the cervix

Surgery: Nervous System

64455, 64479, 64480, 64483, 64484

Revised to be child codes to the parent code 64400

Radiology

71250, 71260, 71270

Revised to include “diagnostic”

71271

Added to report low-dose thorax computed tomography (CT) for lung cancer screening

74425

Revised for clarity, removed “pyelogram, nephrostogram, loopogram”

76145

Report medical physics dose evaluation for radiation exposure that exceeds institutional threshold

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

Switched from Tier 2 codes to Tier 1 codes

Medicine CPT Codes for 2021

90377

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

External electrocardiographic recording, converted from category III codes (0295T, 0296T, 0297T, 0298T) to category 1

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.

86328

Single-step immunoassay antibody detection

86769

Multiple-step immunoassay antibody detection

87635

Infectious agent detection with nucleic acid probe

0202U

Report pathogen detection

87426

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.

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