Getting paid for some of the most routine outpatient office visits became a new challenge on Jan. 1, 2021, when guideline and code descriptor changes for E/M services — previously announced by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) — take effect.
These member tools provide a comprehensive understanding of the coding changes effective since 2021, chart audits and elements of medical decision making (MDM), as well as the Medicare Physician Fee Schedule.
2022 Medicare Physician Fee Schedule (PFS) Tool (non-facility version)
The 2022 Physician Fee Schedule (PFS) tool (non-facility version) is designed to output the Medicare fee schedule based on data from the 2022 final rule. The tool allows you to select your locality and view what the proposed Medicare non-facility reimbursement is projected to be. You can also enter a personalized percentage for providers who have contracts that are based on a percentage of Medicare, which will display in the column labeled “Non-Medicare Non-facility Charges (based on above %).” Medicare’s non-participating, non-facility charges and facility limiting charges are also listed.
2022 Medicare Physician Fee Schedule (PFS) Tool (facility version)
The 2022 Physician Fee Schedule (PFS) tool (facility version) is designed to output the Medicare fee schedule based on data from the 2022 final rule. The tool allows you to select your locality and view what the proposed Medicare facility reimbursement is projected to be. You can also enter a personalized percentage for providers who have contracts that are based on a percentage of Medicare, which will display in the column labeled “Non-Medicare Facility Charges (based on above %).” Medicare’s non-participating facility charges and facility limiting charges are also listed.
2022/2023 Split/Shared Visit and Service Reference
This member-exclusive split/shared visit and service reference details the 2022 and 2023 substantive portion definitions, as well as place of service and modifier usage, for E/M visits in outpatient facilities (excluding office visits in non-facility settings), hospital facilities, and skilled nursing facilities.
2022 CPT® Medical Coding Updates
This member-exclusive resource includes major CPT® code revisions for 2022, including new codes, revised codes, and new, revised and deleted phrasings.
2022 ICD-10-CM Medical Coding Updates
This member-exclusive resource includes major code additions, revisions and deletions that medical practices should know for 2022.
2020, 2021 and 2022 wRVU Variance Calculator
This tool allows you to calculate the work RVU (wRVU) impact — based on the CPT® code and volume for an individual provider or a combined group of providers — from 2020 wRVU values to 2021 and 2022 wRVU values.
E/M Documentation Guidelines, 2021 to Present
This resource includes a downloadable PDF on changes for office or other outpatient E/M codes and guidance for selecting code levels via medical decision making (MDM).
E/M Audit Worksheet (2021 to Present)
This PDF resource includes CPT® definitions for elements of MDM for outpatient office visits, as well as guidance on number and complexity of problems addressed; amount and/or complexity of data to review and analyze; risk of complications and/or morbidity or mortality of patient management; MDM risk scores for new or established patient E/M levels; time-based coding; and prolonged services for Medicare and commercial payers.
Modifier Rate Reduction Information Sheet
This resource helps coders understand appropriate addition of modifiers in coding and billing based on provider documentation as specified on coding guidelines.
Learn more
- MGMA Chart Auditing and Coding Education Services — Available to MGMA members and nonmembers.
- MGMA Consulting — Helping healthcare leaders achieve greater success in their organizations.
