| SERVICE TYPE | LEVEL 1 / SF | LEVEL 2 / LOW | LEVEL 3 / MOD | LEVEL 4 / HIGH | LEVEL 5 / HIGH | PROLONGED CODE |
|---|---|---|---|---|---|---|
| OFFICE NEW | N/A | 99202 (15-29m) | 99203 (30-44m) | 99204 (45-59m) | 99205 (60-74m) | +99417 (CPT) / G2212 |
| OFFICE EST | 99211 (Nurse) | 99212 (10-19m) | 99213 (20-29m) | 99214 (30-39m) | 99215 (40-54m) | +99417 (CPT) / G2212 |
| INIT. INPATIENT | 99221 (40m) | 99222 (55m) | 99223 (75m) | N/A | N/A | +99418 (CPT) / G0316 |
| SUBSQ. INPATIENT | 99231 (25m) | 99232 (35m) | 99233 (50m) | N/A | N/A | +99418 (CPT) / G0316 |
| INPT. CONSULT | N/A | 99252 (35m) | 99253 (45m) | 99254 (60m) | 99255 (80m) | +99418 (CPT) / G0316 |
| ED (MDM ONLY) | 99281 | 99282 | 99283 | 99284 | 99285 | N/A |
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