E/M Code Levels Chart 2026: Complete Reference for Office & Outpatient Visits
E/M code levels define the complexity and reimbursement of Evaluation and Management encounters for office and outpatient visits. Under the AMA 2021 guidelines (effective January 1, 2021 and current through 2026), E/M codes range from 99202 to 99205 for new patients and 99212 to 99215 for established patients, with each level corresponding to a specific Medical Decision Making (MDM) complexity or total encounter time threshold. The chart below provides every E/M code level with its MDM requirements, time ranges, and 2024 national Medicare average reimbursement rates.
This reference covers all office and other outpatient visit codes used for face-to-face and telehealth encounters. Code 99211 (established patient, no physician required) remains available for nurse-level visits. Code 99201 was retired effective January 2021. For prolonged visits exceeding the highest code threshold, add-on code 99417 applies.
Complete E/M Code Levels Chart — New Patients (99202–99205)
| Code | MDM Level | Time | MDM Requirements (meet 2 of 3) | Medicare Avg |
|---|---|---|---|---|
| 99202 | Straightforward | 15–29 min | 1 self-limited problem, minimal data, minimal risk | $76 |
| 99203 | Low | 30–44 min | 2+ self-limited OR 1 stable chronic; limited data; low risk (Rx drugs) | $111 |
| 99204 | Moderate | 45–59 min | 1 chronic with exacerbation OR 1 undiagnosed new problem; moderate data; moderate risk | $170 |
| 99205 | High | 60–74 min | Threat to life/function; extensive data; high risk (hospitalization, IV drugs, DNR) | $224 |
Complete E/M Code Levels Chart — Established Patients (99211–99215)
| Code | MDM Level | Time | MDM Requirements (meet 2 of 3) | Medicare Avg |
|---|---|---|---|---|
| 99211 | N/A (nurse visit) | — | No physician presence required. Typically for nurse-only services (vitals, injections, dressing changes). | $28 |
| 99212 | Straightforward | 10–19 min | 1 self-limited problem, minimal data, minimal risk | $67 |
| 99213 | Low | 20–29 min | 2+ self-limited OR 1 stable chronic; limited data; low risk (Rx drugs) | $109 |
| 99214 | Moderate | 30–39 min | 1 chronic with exacerbation OR 1 undiagnosed new problem; moderate data; moderate risk | $167 |
| 99215 | High | 40–54 min | Threat to life/function; extensive data; high risk (hospitalization, IV drugs, DNR) | $211 |
Prolonged Services: 99417 Add-On Code
When total encounter time exceeds the highest applicable code (99205 for new patients at 74 min, or 99215 for established patients at 54 min), report the base code plus 99417 for each additional 15-minute increment.
| Patient Type | Total Time | How to Bill |
|---|---|---|
| New patient | 75–89 min | 99205 + 99417 x1 |
| New patient | 90–104 min | 99205 + 99417 x2 |
| Established patient | 55–69 min | 99215 + 99417 x1 |
| Established patient | 70–84 min | 99215 + 99417 x2 |
New Patient vs Established Patient: Key Differences
A new patient is one who has not received any professional services from the physician (or another physician of the exact same specialty and subspecialty in the same group) within the past 3 years. All other patients are established.
| Factor | New Patient | Established Patient |
|---|---|---|
| Code range | 99202–99205 | 99211–99215 |
| MDM requirements | Same as established (2-of-3 rule) | Same as new (2-of-3 rule) |
| Time thresholds | Higher (15–74 min range) | Lower (10–54 min range) |
| Reimbursement | 30–50% higher than established | Baseline rates |
| Lowest available code | 99202 (Straightforward MDM) | 99211 (nurse visit, no MDM) or 99212 (Straightforward) |
Reimbursement by Code Level (2024 National Medicare Averages)
The following rates are based on the 2024 Medicare Physician Fee Schedule national averages. Commercial payer rates typically range from 120% to 180% of Medicare depending on contract terms and geography. These figures do not include geographic GPCI adjustments.
| MDM Level | New Patient | Medicare Rate | Established Patient | Medicare Rate |
|---|---|---|---|---|
| Straightforward | 99202 | $76 | 99212 | $67 |
| Low | 99203 | $111 | 99213 | $109 |
| Moderate | 99204 | $170 | 99214 | $167 |
| High | 99205 | $224 | 99215 | $211 |
The revenue gap between 99213 and 99214 is approximately $58 per encounter. For a practice with 20 established patients per day, correcting undercoding on just 3 visits daily means an additional $40,000–$50,000 annually. Our detailed breakdown is available at 99213 vs 99214: When Your Documentation Supports the Higher Code.
Telehealth E/M Coding Rules (2026)
Under CMS telehealth policies extended through 2026, standard office visit E/M codes (99202–99215) apply to real-time audio-visual telehealth encounters. Key rules for telehealth E/M coding:
- Same MDM and time rules apply. The 2-of-3 MDM framework and time-based coding thresholds are identical for in-person and telehealth visits.
- Modifier -95 (synchronous telehealth). Append to the E/M code to indicate the service was delivered via real-time audio-video.
- Place of Service (POS). Use POS 02 (Telehealth Provided Other than in Patient’s Home) or POS 10 (Telehealth in Patient’s Home) per CMS guidance.
- Time documentation. Total time on the encounter date includes all physician activities — video time, pre-visit record review, post-visit documentation, and care coordination. Not just screen time.
- Audio-only visits. Telephone-only E/M services use separate codes 99441 (5–10 min), 99442 (11–20 min), 99443 (21–30 min). These are not interchangeable with standard E/M codes.
For the complete telehealth coding guide including modifier rules and documentation traps, see our article on Telehealth E/M Coding: The 2026 Rules Every Provider Must Know.
Quick Reference: When to Bill Each Code Level
Use this decision guide to quickly identify the appropriate code level for common clinical scenarios:
Single minor problem (cold, rash, insect bite). No labs or imaging. OTC treatment only. Follow-up for well-controlled minor issue.
Routine follow-up for 1 stable chronic condition (controlled HTN, stable DM). Reviewed recent lab results. Continuing current prescription medications.
Chronic condition worsening (A1c rising, BP uncontrolled). New symptom requiring workup. Reviewed labs + ordered new tests. Medication change or dose adjustment. Most common code for multi-problem visits.
Acute condition threatening life or function (chest pain, stroke symptoms, suicidal ideation). Extensive workup (labs + imaging + specialist consult). Decision to hospitalize, start IV therapy, or discuss DNR/code status.
Frequently Asked Questions
What are the E/M code levels for office visits?
E/M (Evaluation and Management) code levels for office and outpatient visits range from straightforward to high complexity. For new patients: 99202 (straightforward), 99203 (low), 99204 (moderate), 99205 (high). For established patients: 99212 (straightforward), 99213 (low), 99214 (moderate), 99215 (high). Code 99211 remains available for nurse visits that do not require physician presence. Codes 99201 and 99211-level physician visits were eliminated under the AMA 2021 guidelines.
What is the difference between 99213 and 99214?
99213 requires Low MDM complexity (2+ self-limited problems or 1 stable chronic, limited data, low risk) OR 20-29 minutes total time for established patients. 99214 requires Moderate MDM complexity (1 chronic illness with exacerbation or 1 undiagnosed new problem, moderate data, moderate risk) OR 30-39 minutes total time. The reimbursement difference is approximately $55-65 per encounter. For a practice seeing 20 patients daily, correctly coding just 3 encounters per day from 99213 to 99214 recovers $40,000-$50,000 annually.
What are the time thresholds for E/M codes in 2026?
Under AMA 2021 guidelines, time-based E/M coding uses total time on the date of encounter (face-to-face + care coordination + documentation). New patient thresholds: 99202 (15-29 min), 99203 (30-44 min), 99204 (45-59 min), 99205 (60-74 min). Established patient thresholds: 99212 (10-19 min), 99213 (20-29 min), 99214 (30-39 min), 99215 (40-54 min). For time beyond 99205/99215, add-on code 99417 applies for each additional 15 minutes.
What are the Medicare reimbursement rates for E/M codes?
Based on 2024 National Medicare Physician Fee Schedule averages: 99202 ($76), 99203 ($111), 99204 ($170), 99205 ($224) for new patients. 99212 ($67), 99213 ($109), 99214 ($167), 99215 ($211) for established patients. Commercial payer rates are typically 120-180% of Medicare. Actual rates vary by locality and GPCI adjustments.
How do I choose between MDM-based and time-based E/M coding?
Under AMA 2021 guidelines, you can bill based on either MDM complexity or total encounter time — whichever yields the higher code. Always document both when possible. Time-based coding is especially advantageous for care coordination-heavy visits (e.g., managing multiple stable chronic conditions with extensive phone calls, record review, and care planning) where the clinical complexity may be low but time investment is high. AI tools like CodeItRight.ai automatically compare both methods and recommend the higher-paying code.
Do E/M codes apply to telehealth visits?
Yes. Under the 2021 AMA guidelines and CMS telehealth policies extended through 2026, standard E/M codes (99202-99215) apply to real-time audio-visual telehealth encounters. Append modifier -95 (synchronous telehealth) or the appropriate place-of-service code. Time-based coding for telehealth includes all physician activities on the encounter date, not just screen time. Audio-only visits (telephone E/M) use separate codes 99441-99443 with different time thresholds.
What happened to 99201 and the old E/M coding system?
The AMA 2021 E/M guidelines eliminated code 99201 (new patient, straightforward) because its requirements were identical to 99202. The entire history/exam-based coding system was retired for office and outpatient visits. Code selection now relies exclusively on MDM complexity or total encounter time. 99211 remains for established patient visits that do not require physician presence (nurse visits). These changes simplified coding but require physicians to understand MDM scoring and time documentation rules.
What is the 99417 prolonged services add-on code?
99417 is the add-on code for prolonged office/outpatient services beyond the time thresholds for 99205 (new patient, 60-74 min) or 99215 (established patient, 40-54 min). Each unit of 99417 covers an additional 15 minutes. For example, a 90-minute established patient visit would be billed as 99215 + 99417 x2 (55-69 min = first 99417, 70-84 min = second 99417). The code requires time-based documentation and cannot be used with MDM-based coding alone.
Let AI Select the Right Code for You
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For hands-on practice, try the manual E/M calculator or the interactive coding scenarios. For a printable quick reference, see the 2026 E/M Coding Cheat Sheet. For a deep dive into MDM scoring, read What Is Medical Decision Making in E/M Coding?.
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Source: AMA 2021 E/M Documentation Guidelines, CMS Table of Risk, 2024 Medicare Physician Fee Schedule. For educational purposes only — not legal or medical advice.