E/M Patient Criteria

Aka: E/M Patient Criteria, E/M New Patient, E/M Established Patient

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II. Patient Type: New

  1. Description: New to group specialty within 3 years
    1. No physician from same specialty in the same group
    2. No professional services in the last 3 years
  2. Related E/M Codes for outpatient services
    1. CPT 99201
    2. CPT 99202
    3. CPT 99203
    4. CPT 99204
    5. CPT 99205

III. Patient Type: Established

  1. Description: Care from group specialty within 3 years
    1. Physician from same specialty in the same group
    2. Professional services in the last 3 years
    3. Includes call coverage
  2. Related E/M Codes for outpatient services
    1. CPT 99211
    2. CPT 99212
    3. CPT 99213
    4. CPT 99214
    5. CPT 99215

IV. Patient Type: Not Applicable

  1. Description: New and established patients charged same
    1. E/M Emergency Services
    2. E/M Consultation Services

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