Time-based vs MDM E/M selection
Two paths to an office E/M level: total time on the date of service, or the medical decision making framework. Pick whichever path the encounter supports.
Last reviewed May 24, 2026
Side by side
Time-based selection
Choose the E/M level by total time spent on the encounter on the date of service, summed across pre-/intra-/post-visit work by the billing clinician.
AMA CPT E/M Guidelines (time)- Only the date of the encounter counts (per 2021+ rules).
- All clinician time — chart review, the visit itself, documentation, ordering — counts.
- Does not include staff time.
MDM-based selection
Choose the E/M level by the medical decision making framework: number/complexity of problems, amount/complexity of data, and risk of complications.
AMA CPT E/M Guidelines (MDM)- Two of three MDM elements must meet or exceed the level.
- Prescription drug management = moderate risk on its own.
When to use Time-based selection
- A 99214-or-higher visit dominated by counseling and coordination of care.
- Documentation is stronger on time than on MDM elements.
When to use MDM-based selection
- A visit where the chart cleanly supports moderate or high MDM but the visit was efficient.
- Prescription drug management + multiple stable chronic conditions.
Common mistakes
- Counting time spent the day before or after the encounter (not allowed since 2021).
- Choosing time-based selection without documenting total time and the activities performed.
- Choosing MDM but only meeting one of the three elements at the claimed level.
Sources
- AMA CPT E/M Guidelineshttps://www.ama-assn.org/practice-management/cpt/cpt-evaluation-and-management
- CMS — E/M Office Visits 2021 Final Policyhttps://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/em-visits
Related
Test the level both ways in Ask D3
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This comparison is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at CMS, HHS, OCR, eCFR, NIST, and the relevant payer or state regulator. Last reviewed May 24, 2026.