Exception for Evaluation and Management (E/M) Services in Certain Primary Care Centers

Effective January 1, 2022, teaching physicians may use only medical decision making (MDM) for purposes of E/M visit level selection when billing the Medicare program under the physician fee schedule for office or outpatient E/M visits via a primary care exception.

Time-Based Codes

Additional updates apply to office or outpatient E/M visit codes for which total time is used for the visit level selection. For purposes of selecting the visit level, only count time spent by the teaching physician performing qualifying activities listed by CPT (with or without direct patient contact on the date of the encounter), including the time the teaching physician is present when a resident is performing such activities.

For purposes of payment, E/M services billed by teaching physicians require that the medical records must demonstrate:

• The teaching physician performed the service or was physically present during the key or critical portions of the service when performed by the resident; and
• Participation of the teaching physician in the management of the patient.

Source: Medicare Claims Processing Manual, Chapter 12 - Physicians/Nonphysician Practitioners, Section 100