CMS Assignment Methodology: CPT Codes 

Office or Other Outpatient Services

 

99201 New Patient, brief
99202 New Patient, limited
99203 New Patient, moderate
99204 New Patient, comprehensive 99205 New Patient, extensive
99211 Established Patient, brief
99212 Established Patient, limited
99213 Established Patient, moderate 99214 Established Patient, comprehensive 99215

 

Established Patient, extensive 

Initial Nursing Facility Care

99304 New or Established Patient, brief
99305 New or Established Patient, moderate 99306 New or Established Patient, comprehensive

 

Subsequent Nursing Facility Care

99307 New or Established Patient, brief
99308 New or Established Patient, limited
99309 New or Established Patient, comprehensive 99310 New or Established Patient, extensive

 

Nursing Facility Discharge Services

99315 New or Established Patient, brief

99316 New or Established Patient, comprehensive

Other Nursing Facility Services

99318 New or Established Patient

Domiciliary, Rest Home, or Custodial Care Services

99324 New Patient, brief 99325 New Patient, limited 99326 New Patient, moderate 


11 CPT is copyright 2011 American Medical Association. All rights reserved. 26
Table 2. Primary care codes included in beneficiary assignment criteria (continued)
Primary Care Codes and Services


99327 New Patient, comprehensive
99328 New Patient, extensive
99334 Established Patient, brief
99335 Established Patient, moderate 99336 Established Patient, comprehensive 99337 Established Patient, extensive
Domiciliary, Rest Home, or Home Care Plan Oversight Services
99339, brief
99340, comprehensive
Home Services
99341 New Patient, brief
99342 New Patient, limited
99343 New Patient, moderate
99344 New Patient, comprehensive
99345 New Patient, extensive
99347 Established Patient, brief
99348 Established Patient, moderate
99349 Established Patient, comprehensive
99350 Established Patient, extensive
99490 Chronic Care Management Service, 20 minutes
99495 Transitional Care Management Services within 14 days of discharge 99496 Transitional Care Management Services within 7 days of discharge
Wellness Visits
G0402 Welcome to Medicare visit G0438 Annual wellness visit G0439 Annual wellness visit
New G code for Outpatient Hospital Claims
G0463 Hospital outpatient clinic visit (see note below)
For FQHC services furnished prior to 1/1/2011, primary care services include services identified by HCPCS code G0402 (effective 1/1/2009) or the following revenue center codes:
0521 Clinic visit by member to RHC/FQHC
0522 Home visit by RHC/FQHC practitioner
0524 Visit by RHC/FQHC practitioner to a member, in a covered Part A stay at the SNF
0525 Visit by RHC/FQHC practitioner to a member in an SNF (not in a covered Part A stay) or NF or ICF MR or other residential facility
27
(continued)

Table 2. Primary care codes included in beneficiary assignment criteria (continued)

Primary Care Codes and Services

For RHC services, primary care services include services identified by HCPCS code G0402 (effective 1/1/2009) or G0438 (effective 1/1/2011), G0439 (effective 1/1/2011) or the following revenue center codes:

0521 Clinic visit by member to RHC/FQHC
0522 Home visit by RHC/FQHC practitioner
0524 Visit by RHC/FQHC practitioner to a member, in a covered Part A stay at the SNF

0525 Visit by RHC/FQHC practitioner to a member in an SNF (not in a covered Part A stay) or NF or ICF MR or other residential facility 

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