skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. For the most comprehensive experience, we encourage you to visit Medicare.gov or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.
Join eNews       En Español
Text Size:
YouTube LinkedIn Email Print
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]
Last Modified: 8/5/2022 Location: FL, PR, USVI Business: Part A, Part B

E/M FAQ -- Determining overall risk for medical decision-making

Q. Is prescription drug management enough to establish a moderate level of risk for medical decision-making?
A. The risk of significant complications, morbidity, and/or mortality of patient management is based on the risks associated with the following categories:
Presenting problem(s);
Diagnostic procedure(s); and
Possible management options
The assessment of risk of selecting diagnostic procedures and management options is based on the risk during and immediately following any procedures or treatment. The highest level of risk in any one category determines the overall risk, and in the category of possible management options, prescription drug management is an example of a moderate level of risk.

Changes to office and outpatient evaluation and management (E/M) services for 2021

NOTICE -- Effective for dates of service on and after January 1, 2021, practitioners have the choice to document office and outpatient E/M visits via medical decision making (MDM) or time. CMS adopted the American Medical Association's (AMA's) CPT revised guidance, including deletion of CPT code 99201. The E/M code and guideline changes are specific for office and other outpatient visits and apply to codes 99201-99205 and 99211-99215. Based on the CPT changes, code 99201 is no longer valid for dates of service on and after January 1, 2021, as clinicians may choose the E/M visit level based on either medical decision making or time, both CPT code 99201 and 99202 previously require straightforward medical decision making, therefore the decision was made to delete CPT code 99201.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.