Evaluation and management services
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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
Find helpful tips through our Understanding E/M article.
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.