Evaluation and Management Services
Spotlight
Dermatologists: Bill Correctly for Evaluation and Management Services & Minor Surgical Procedures
In a report, the Office of Inspector General found that in 2019 and 2020, approximately 61.5% of Medicare dermatology claims for evaluation and management (E/M) services included a minor surgical procedure on the same day performed by the same dermatologist. These E/M services are generally included in the cost of the minor surgical procedure under Medicare global surgery rules. You should not be paid separately for the E/M component unless a significant, separately identifiable E/M service was performed.
Review the Evaluation and Management Services (PDF) booklet and learn how to bill correctly:
- Use modifier 25 for a significant and separately identifiable service unrelated to the decision to perform the minor surgical procedure
- Maintain medical record documentation to support the level of service
Additional Modifier 25 resources:
Self-Service Tools and Resources
E/M Interactive Worksheet - use this self-service tool to calculate a suggested E/M code based on your entries that best reflects the level of E/M services performed.
Incident-To Self-Service Tool - use this self-service tool to assist in identifying the appropriate application of incident-to requirements.
Additional Incident-To Resources:
- Incident-To Services - view additional incident-to services information, including links to related CMS resources and references.
Coding and Guidelines
- CMS Evaluation and Management Guide
- CMS IOM Pub. 100-04, Chapter 12, section 30.6 - E/M service codes
- AMA's 2021 Changes to Office and Outpatient E/M services
- AMA's 2023 Changes to Other E/M visits
- CPT E/M Office Revisions - Medical Decision Making (MDM)
- CMS Evaluation and Management Visits: This page contains guidance regarding documentation and payment under the Medicare Physician Fee Schedule for evaluation and management (E/M) visits.
Care Management Services
Care management services are covered under the Medicare program. View information regarding care management services, including links to related CMS resources and references.
Additional Resources
E/M Services Documentation Checklist: This checklist is intended to provide health care providers with a reference for use when responding to additional documentation requests for E/M services
Visit the Specialty / Services FAQs for additional information.