Updated 2021 E/M Reimbursement Policy

Effective Jan. 1, 2021, we will be updating our reimbursement policy to follow the revised 2021 Evaluation and Management (E&M) CPT® coding and guideline changes from the American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS).  

These are the first significant changes to E&M codes in nearly 30 years and will require you to make changes to your billing practices. AMA has set up an Implementing CPT® Evaluation and Management (E&M) revisions site to help with the transition. This site contains free educational modules and step-by-step details to help you understand these new guidelines. 

We recommend practice managers and coding specialists review the following:

  • Three free educational modules
    • E&M changes overview
    • Time
    • Medical decision making (MDM)
  • Checklist for Health Systems
  • Videos with step-by-step directions
  • AMA & Nordic webinar detailing E&M changes and Physician Documentation

These guideline changes have the potential to significantly reduce physician burden while improving patient care.

UnitedHealthcare is here to support your efforts to improve coding accuracy by providing education materials and proactive outreach. Check out the Coding Corner for the latest on-demand coding guides.

If you have any questions on UnitedHealthcare coding education, please reach out to a coding specialist at education.info@optum.com.

CPT® is a registered trademark of the American Medical Association.