Medical Decision-Making Table (MDM) with Associated Evaluation & Management CPT® Codes

Code Level of MDM ▶ Elements of MDM

(Based on 2 out
of 3 Elements of Number and Complexity of Problems Amount and/or Complexity of Data to be Risk of Complications and/or
MDM) Addressed at the Encounter Reviewed and Analyzed Morbidity or Mortality of
*Each unique test, order, or document contributes to Patient Management
the combination of 2 or combination of 3 in
Category 1 below.
99211 N/A N/A N/A N/A
99281
99202 Straightforward Minimal Minimal or none Minimal risk of morbidity from
99212 • 1 self-limited or minor problem additional diagnostic testing or
99221* treatment
99231*
99234*
99242
99252
99282
99304*
99307
99341
99347
99203 Low Low Limited Low risk of morbidity from
99213 • 2 or more self-limited or minor (Must meet the requirements of at least 1 of the 2 additional diagnostic testing or
99221* problems; categories) treatment
99231*
99234* or Category 1: Tests and documents
99243 • 1 stable chronic illness; • Any combination of 2 from the following:
99253 ▪ Review of prior external note(s) from each
99283 or
unique source*;
99304* • 1 acute, uncomplicated illness or
▪ Review of the result(s) of each unique test*;
99308 injury;
▪ Ordering of each unique test*
99342
99348 or
or
• 1 stable, acute illness;

or Category 2: Assessment requiring an independent

• 1 acute, uncomplicated illness or historian(s)
(For the categories of independent interpretation of
injury requiring hospital inpatient or
tests and discussion of management or test
observation level of care interpretation, see moderate or high)

1
Medical Decision-Making Table (MDM) with Associated Evaluation & Management CPT® Codes

Code Level of MDM ▶ Elements of MDM

(Based on 2 out
of 3 Elements of Number and Complexity of Problems Amount and/or Complexity of Data to be Risk of Complications and/or
MDM) Addressed at the Encounter Reviewed and Analyzed Morbidity or Mortality of
*Each unique test, order, or document contributes to Patient Management
the combination of 2 or combination of 3 in
Category 1 below.
99204 Moderate Moderate Moderate Moderate risk of morbidity
99214 • 1 or more chronic illnesses with (Must meet the requirements of at least 1 out of 3 from additional diagnostic
99222 exacerbation, progression, or side categories) testing or treatment
99232 effects of treatment; Category 1: Tests, documents, or independent
99235 historian(s) Examples only:
99244 or • Any combination of 3 from the following: • Prescription drug
99254 ▪ Review of prior external note(s) from management
99284 • 2 or more stable chronic illnesses; each unique source*; • Decision regarding
99305 ▪ Review of the result(s) of each unique minor surgery with
99309 or test*; identified patient or
99344 ▪ Ordering of each unique test*; procedure risk factors
99349 • 1 undiagnosed new problem with ▪ Assessment requiring an independent • Decision regarding
uncertain prognosis; historian(s) elective major surgery
or without identified
or patient or procedure risk
Category 2: Independent interpretation of tests factors
• 1 acute illness with systemic • Independent interpretation of a test • Diagnosis or treatment
symptoms; performed by another physician/other significantly limited by
qualified health care professional (not social determinants of
or separately reported); health
or
• 1 acute complicated injury
Category 3: Discussion of management or test
interpretation
• Discussion of management or test
interpretation with external physician/other
qualified health care professional/appropriate
source (not separately reported)

2
Medical Decision-Making Table (MDM) with Associated Evaluation & Management CPT® Codes

Code Level of MDM ▶ Elements of MDM

(Based on 2 out
of 3 Elements of Number and Complexity of Problems Amount and/or Complexity of Data to be Risk of Complications and/or
MDM) Addressed at the Encounter Reviewed and Analyzed Morbidity or Mortality of
*Each unique test, order, or document contributes to Patient Management
the combination of 2 or combination of 3 in
Category 1 below.
99205 High High Extensive High risk of morbidity from
99215 • 1 or more chronic illnesses with (Must meet the requirements of at least 2 out of 3 additional diagnostic testing or
99223 severe exacerbation, progression, or categories) treatment
99233 side effects of treatment;
99236 or Category 1: Tests, documents, or independent Examples only:
99245 historian(s) • Drug therapy requiring
99255 • 1 acute or chronic illness or injury • Any combination of 3 from the following: intensive monitoring for
99285 that poses a threat to life or bodily ▪ Review of prior external note(s) from toxicity
99306 function each unique source*; • Decision regarding
99310 ▪ Review of the result(s) of each unique elective major surgery
99345 test*; with identified patient or
99350 ▪ Ordering of each unique test*; procedure risk factors
▪ Assessment requiring an independent • Decision regarding
historian(s) emergency major
surgery
or • Decision regarding
hospitalization
Category 2: Independent interpretation of tests • Decision not to
• Independent interpretation of a test resuscitate or to de-
performed by another physician/other escalate care because of
qualified health care professional (not poor prognosis
separately reported); • Parenteral controlled
substances◀
or

Category 3: Discussion of management or test

interpretation
• Discussion of management or test
interpretation with external physician/other
qualified health care professional/appropriate
source (not separately reported)

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Medical Decision-Making Table (MDM) with Associated Evaluation & Management CPT® Codes

*Codes denoted with an asterisk (*) may be used for either straightforward or low-level medical decision making (MDM) based on
what is included in the code descriptor.

This table does not replace individual physician or other qualified health care professional (QHP) judgement in determining the
appropriate level of medical decision-making for an encounter. Additionally, consult the CPT® Professional book for additional
information on E/M guidelines as well as definitions of terms.

This reference table is for medical coding guidance purposes only. It (i) does not supersede or replace the AMA’s Current Procedural
Terminology® manual (“CPT Manual”) or other coding authority, (ii) does not constitute clinical advice, (iii) does not dictate payer
reimbursement policy, and (iv) does not substitute for the professional judgement of the practitioner performing a procedure, who
remains responsible for correct coding.