Crystal's MCW Coder Hub| CPT or HCPCS Code | Service Description | Global Period (Days) | MDM Level | Total Time (Minutes) | Clinical Specialty |
|---|---|---|---|---|---|
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient. | 0 | Straightforward | 15-29 | General Medicine, Ophthalmology, Urology, Nephrology, Emergency Medicine, Infectious Diseases |
| 99203 | Office or other outpatient visit for the evaluation and management of a new patient. | 0 | Low | 30-44 | General Medicine, Ophthalmology, Urology, Nephrology, Emergency Medicine, Infectious Diseases, ENT |
| 99204 | Office or other outpatient visit for the evaluation and management of a new patient. | 0 | Moderate | 45-59 | General Medicine, Ophthalmology, Urology, Nephrology, Emergency Medicine, Infectious Diseases, Otolaryngology |
| 99205 | Office or other outpatient visit for the evaluation and management of a new patient. | 0 | High | 60-74 | General Medicine, Ophthalmology, Urology, Nephrology, Emergency Medicine, Infectious Diseases, Otolaryngology |
| Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional. | 0 | Straightforward | 5 | Ophthalmology | |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient. | 0 | Straightforward | 10-19 | General Medicine, Ophthalmology, Urology, Nephrology, Emergency Medicine, Infectious Diseases, Otolaryngology |
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient. | 0 | Low | 20-29 | General Medicine, Ophthalmology, Urology, Nephrology, Emergency Medicine, Infectious Diseases, Otolaryngology |
| 99214 | Office or other outpatient visit for the evaluation and management of an established patient. | 0 | Moderate | 30-39 | General Medicine, Ophthalmology, Urology, Nephrology, Emergency Medicine, Infectious Diseases, Otolaryngology |
| 99215 | Office or other outpatient visit for the evaluation and management of an established patient. | 0 | High | 40-54 | General Medicine, Ophthalmology, Urology, Nephrology, Emergency Medicine, Infectious Diseases, Otolaryngology |
| 99221 | Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient. | 0 | Straightforward or Low | 40 | Infectious Diseases, Internal Medicine, Hospitalist |
| 99222 | Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient. | 0 | Moderate | 55 | Infectious Diseases, Internal Medicine, Hospitalist |
| 99223 | Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient. | 0 | High | 75 | Infectious Diseases, Internal Medicine, Hospitalist |
| 99231 | Subsequent hospital inpatient or observation care, per day. | 0 | Straightforward or Low | 25 | Not in source |
| 99232 | Subsequent hospital inpatient or observation care, per day. | 0 | Moderate | 35 | Not in source |
| 99233 | Subsequent hospital inpatient or observation care, per day. | 0 | High | 50 | Hospitalist |
| 99234 | Hospital inpatient or observation care, including admission and discharge on the same date. | 0 | Straightforward or Low | 45 | Not in source |
| 99235 | Hospital inpatient or observation care, including admission and discharge on the same date. | 0 | Moderate | 70 | Not in source |
| 99236 | Hospital inpatient or observation care, including admission and discharge on the same date. | 0 | High | 85 | Hospitalist |
| 99242 | Office or other outpatient consultation for a new or established patient. | 0 | Straightforward | 20 | Not in source |
| 99243 | Office or other outpatient consultation for a new or established patient. | 0 | Low | 30 | Not in source |
| 99244 | Office or other outpatient consultation for a new or established patient. | 0 | Moderate | 40 | Not in source |
| 99245 | Office or other outpatient consultation for a new or established patient. | 0 | High | 55-84 | Not in source |
| 99252 | Inpatient or observation consultation for a new or established patient. | 0 | Straightforward | 35 | Not in source |
| 99253 | Inpatient or observation consultation for a new or established patient. | 0 | Low | 45 | Not in source |
| 99254 | Inpatient or observation consultation for a new or established patient. | 0 | Moderate | 60 | Not in source |
| 99255 | Inpatient or observation consultation for a new or established patient. | 0 | High | 80-109 | Not in source |
| 99281 | Emergency department visit for the evaluation and management of a patient. | 0 | N/A | Not in source | Emergency Medicine |
| 99282 | Emergency department visit for the evaluation and management of a patient. | 0 | Straightforward | Not in source | Emergency Medicine |
| 99283 | Emergency department visit for the evaluation and management of a patient. | 0 | Low | Not in source | Emergency Medicine |
| 99284 | Emergency department visit for the evaluation and management of a patient. | 0 | Moderate | Not in source | Emergency Medicine |
| 99285 | Emergency department visit for the evaluation and management of a patient. | 0 | High | Not in source | Emergency Medicine |
| 99291 | Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes. | 0 | High | 30-74 | Infectious Diseases, Critical Care |
| 99292 | Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes. | 0 | Not in source | 30 | Not in source |
| 99306 | Initial nursing facility care, per day. | 0 | High | 50 | Geriatrics |
| 99310 | Subsequent nursing facility care, per day. | 0 | High | 45 | Geriatrics |
| 99345 | Home or residence visit for the evaluation and management of a new patient. | 0 | High | 75 | Home Health |
| 99350 | Home or residence visit for the evaluation and management of an established patient. | 0 | High | 60 | Home Health |
| 92002 | Ophthalmological services: medical examination and evaluation; intermediate, new patient. | 0 | Low | Not in source | Ophthalmology |
| 92004 | Ophthalmological services: medical examination and evaluation; comprehensive, new patient. | 0 | Not in source | Not in source | Ophthalmology |
| 92012 | Ophthalmological services: medical examination and evaluation; intermediate, established patient. | 0 | Not in source | Not in source | Ophthalmology |
| 92014 | Ophthalmological services: medical examination and evaluation; comprehensive, established patient. | 0 | Not in source | Not in source | Ophthalmology |
| 92015 | Refraction; Vision exam to determine a new prescription. | 0 | Not in source | Not in source | Ophthalmology, Optometry |
| 10030 | Image-guided fluid collection drainage by catheter. | 0 | Not in source | Not in source | Urology, Nephrology |
| 10035 | Placement of soft tissue localization device(s); first lesion. | 0 | Not in source | Not in source | Urology, Nephrology |
| 10040 | Acne surgery. | 10 | Not in source | Not in source | Ophthalmology, Urology, Nephrology, Dermatology |
| 10060 | Incision and drainage of abscess; simple or single. | 10 | Low | Not in source | Dermatology, Ophthalmology, Urology, Nephrology, General Surgery |
| 10061 | Incision and drainage of abscess; complicated or multiple. | 10 | Moderate | Not in source | Dermatology, Urology, Nephrology |
| 10120 | Incision and removal of foreign body, subcutaneous tissues; simple. | 10 | Not in source | Not in source | Ophthalmology |
| 11055 | Paring or cutting of benign hyperkeratotic lesion; single lesion. | 0 | Not in source | Not in source | Dermatology |
| 11400 | Excision, benign lesion including margins, except skin tag, trunk, arms or legs; excised diameter 0.5 cm or less. | 10 | Not in source | Not in source | Ophthalmology |
| 11450 | Excision of skin and subcutaneous tissue for hidradenitis; with simple or intermediate repair. | 90 | Moderate | Not in source | Dermatology, Ophthalmology, Urology, Nephrology |
| 11626 | Excision of malignant lesion (scalp, neck, trunk, etc.); excised diameter > 4.0 cm. | 10 | Not in source | Not in source | Dermatology |
| 11640 | Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.5 cm or less. | 10 | Not in source | Not in source | Ophthalmology |
| 11720 | Debridement of nail(s) by any method(s); 1 to 5. | 0 | Not in source | Not in source | Dermatology |
| 11750 | Excision of nail and nail matrix, partial or complete, for permanent removal. | 10 | Not in source | Not in source | Dermatology, Podiatry |
| 13160 | Secondary closure of surgical wound or dehiscence, extensive or complicated. | 90 | Not in source | Not in source | Not in source |
| 15822 | Blepharoplasty, upper eyelid. | 90 | Not in source | Not in source | Ophthalmology |
| 15823 | Blepharoplasty, upper eyelid; with excessive skin weighting down lid. | 90 | Not in source | Not in source | Ophthalmology |
| 19301 | Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, or segmentectomy). | 90 | Not in source | Not in source | Oncology, Surgery |
| 19302 | Mastectomy, partial; with axillary lymphadenectomy. | 90 | Not in source | Not in source | Not in source |
| 27130 | Arthroplasty, acetabular and proximal femoral replacement (total hip arthroplasty), with or without autograft or allograft. | 90 | Not in source | Not in source | Orthopedics |
| 27447 | Arthroplasty, knee, condyle and plateau; total knee arthroplasty, with or without prosthesis. | 90 | Not in source | Not in source | Orthopedics |
| 30520 | Septoplasty or submucous resection of nasal septum. | 90 | Not in source | Not in source | Otolaryngology (ENT) |
| 31231 | Nasal endoscopy, diagnostic, unilateral or bilateral. | 0 | Not in source | Not in source | Otolaryngology (ENT) |
| 31237 | Nasal debridement after endoscopic sinus surgery. | 0 | Not in source | Not in source | Otolaryngology |
| 31239 | Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy. | 10 | Not in source | Not in source | Otolaryngology |
| 31253 | Nasal/sinus endoscopy, surgical with ethmoidectomy; total. | 0 | Not in source | Not in source | Otolaryngology (ENT) |
| 31575 | Laryngoscopy, flexible; diagnostic. | 0 | Not in source | Not in source | Otolaryngology (ENT) |
| 33405 | Replacement, aortic valve, with cardiopulmonary bypass; with prosthetic valve. | 90 | Not in source | Not in source | Cardiology, Cardiothoracic Surgery |
| 38220 | Diagnostic bone marrow, aspiration(s). | 0 | Not in source | Not in source | Not in source |
| 38221 | Diagnostic bone marrow biopsy(ies). | 0 | Not in source | Not in source | Not in source |
| 38222 | Diagnostic bone marrow; biopsy(ies) and aspiration(s). | 0 | Not in source | Not in source | Not in source |
| 42820 | Tonsillectomy and adenoidectomy; under age 12. | 90 | Not in source | Not in source | Otolaryngology (ENT) |
| 46606 | Anoscopy; with biopsy, single or multiple. | 0 | Not in source | Not in source | Not in source |
| 50688 | Change of ureter tube or stent via ileal conduit. | 0 | Not in source | Not in source | Urology |
| 52000 | Cystourethroscopy (separate procedure). | 0 or 10 | Not in source | Not in source | Urology |
| 52204 | Cystourethroscopy, with biopsy(s). | 0 | Not in source | Not in source | Urology |
| 52400 | Cystourethroscopy with incision or resection of obstructive hypertrophic mucosal folds. | 90 | Not in source | 5-10 | Urology |
| 55250 | Vasectomy, unilateral or bilateral (separate procedure). | 90 | Moderate | Not in source | Urology |
| 58262 | Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s). | 90 | Not in source | Not in source | G |
| 61546 | Craniotomy for hypophysectomy; intracranial approach. | 90 | Not in source | Not in source | Neurosurgery |
| 62165 | Neuroendoscopy, intracranial; with excision of a pituitary tumor. | 90 | Not in source | Not in source | Neurosurgery, Otolaryngology |
| 66984 | Extracapsular cataract removal with insertion of intraocular lens prosthesis. | 90 | Not in source | Not in source | Ophthalmology |
| 67028 | Intravitreal injection of a pharmacologic agent. | 0 or 10 | Not in source | Not in source | Ophthalmology |
| 67113 | Repair of complex retinal detachment (eg, proliferative vitreoretinopathy). | 90 | Not in source | Not in source | Ophthalmology, Retina |
| 69433 | Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia. | 10 | Not in source | Not in source | Otolaryngology (ENT) |
| 70130 | Radiologic examination, mastoids; complete, minimum of 3 views per side. | Not in source | Not in source | Not in source | Not in source |
| 77066 | Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral. | Not in source | Not in source | Not in source | Not in source |
| G0108 | Diabetes outpatient self-management training services, individual, per 30 minutes. | Not in source | Not in source | 30 | Not in source |
| G0109 | Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes. | Not in source | Not in source | 30 | Not in source |
| G0316 | Prolonged hospital inpatient or observation care E/M service(s) each additional 15 minutes. | Not in source | Not in source | 15 | Not in source |
| G0559 | Post-operative follow-up visit complexity inherent to E/M services addressing a surgical procedure. | 90 | Not in source | 5.5 | Ophthalmology, Otolaryngology, Urology |
| G2082 | Outpatient visit for E/M including provision of up to 56 mg of esketamine and 2 hours observation. | Not in source | Not in source | 120 | Psychiatry |
| G2083 | Outpatient visit for E/M including provision of more than 56 mg of esketamine and 2 hours observation. | Not in source | Not in source | 120 | Psychiatry |
| G9485 | Remote in-home visit for the evaluation and management of a new patient; 60 minutes. | Not in source | High | 60 | Not in source |
| Q4381 | hd derm per sq cm. | 0 | Not in source | Not in source | Dermatology |
[1] https://www.optumcoding.com/upload/docs/Emergency%20_Medicine_AEMC25_RVUS_and_Medicare_Edits.pdf
[2] https://www.optumcoding.com/upload/docs/Ophthalmology_ATEY25_RVUS_and_Medicare_Edits.pdf
[3] LCD - Scanning Computerized Ophthalmic Diagnostic Imaging (L35038) - CMS
[4] MLN006764 - Evaluation and Management Services - CMS
[5] 2025 MS-DRG v42.0 List
[6] AAPC_2024_EM_Worksheet.pdf
[7] Office/Outpatient Evaluation and Management Services Reference Guide and Clinical Examples - IDSA
[8] 2021 EM Office Visit Primer.pdf
[9] https://www.optumcoding.com/upload/docs/Ophthalmology_ATEY_CCI_31.0.pdf
[10] Printed Notes2.pdf
[11] https://www.optumcoding.com/upload/docs/Emergency_Medicine_AEMC_CCI_31.0.pdf
[12] https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf
[13] EM-Audit-Tool-Comprehensive by Perplexity.pdf
[14] Comprehensive List of Commonly Used Urology CPT Codes
[15] Most Common Otolaryngology (ENT) CPT Codes 2024 - MediBillMD
[16] https://www.ama-assn.org/system/files/2019-06/cpt-revised-mdm-grid.pdf
[17] https://www.optumcoding.com/upload/docs/Urology_Nephrology_ATUN25_RVUS_and_Medicare_Edits.pdf
[18] All notes 12/15/2025
[19] Evaluation and Management (E/M) Office Visits—2021 - American Medical Association
[20] Urology CPT Codes and Modifiers for 2025 - Quest National Services
[21] Retina Coding Update
[22] Level of service for vasectomy prompts coding confusion - Urology Times
[23] Simplifying Coding—5 Steps to Choosing the Right E/M or Eye Visit Code
[24] ENT Billing in 2025: Coding Updates, Modifier Rules & Reimbursement Guide
[25] EMAuditToolwithProlongedServices.pdf
[26] E/M guidelines require a different approach to documentation - Urology Times
[27] 2025 Ophthalmology Billing Codes Cheat Sheet: Streamline Your Practice
[28] Accurately Billing for Cystoscopy - Medisys Data Solutions
[29] https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf
[30] Printed notes.pdf
[31] 2023 Emergency Department E/M Guidelines
[32] acep audit tool 11.2023.pdf
[33] Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Acquisition; Rural Emergency Hospitals: Payment Policies, Conditions of Participation, Provider Enrollment, Physician Self-Referral; New Service Category for Hospital Outpatient Department Prior Authorization Process; Overall Hospital Quality Star Rating; COVID-19 - Federal Register
[34] https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00081590
[35] 2025 Medicare NCCI Policy Manual - Chapter 1_REVISED_FINAL - CMS
[36] Ophthalmology CPT Codes and Modifiers for 2025 - Quest National Services
[37] Coding: Refraction: 92015 - Optometric Management
[38] CMS Global Procedure Codes and Descriptors
[39] All notes 11/10/2025
[40] AAO-HNS Coding Resources
[41] CG-SURG-24 Functional Endoscopic Sinus Surgery (FESS) - Healthy Blue North Carolina Providers
[42] Reporting CPT Modifier 25 - American Medical Association
[43] Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - October 2025 Update
[44] Comprehensive Analysis of Urology Outpatient and Inpatient Medical Coding
[45] CPT Codes For Urology Procedures & Coding Guidelines 2024 - MediBillMD
[46] Coding for Urologic Office Procedures - Abdominal Key
[47] Which CPT Codes are Used in Vasectomy Billing? - Medwave
[48] Coding and Reimbursement for Endoscopic Endonasal Surgery of the Skull Base - NIH
[49] Expert Analysis of Ophthalmology Medical Coding Guidelines and Procedures
[50] MLN907166 - Global Surgery - CMS
[51] Documenting Complex Retina Repair - American Academy of Ophthalmology
[52] Coding Reassessment for Complex Retinal Detachment Repair - Riva Lee Asbell Associates
[53] Calendar Year 2025 Medicare Physician Fee Schedule and Quality Payment Program Final Rule Report
[54] hcpc2025 oc anwaeb.pdf
[55] Reimbursement Policy: Coding Edit Rules (Commercial, Medicare & Medicaid) - EmblemHealth
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