MLN: Time-Based E/M Coding
Reference to the CMS rules for selecting an E/M code by total time on the date of the encounter, including the activities that count and prolonged service add-ons.
Primary source
MLN Booklet — Evaluation and Management Services Guide →https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/eval-mgmt-serv-guide-icn006764.pdf
Verified May 23, 2026 · This is the authoritative regulator URL. The summary below is a research aid; the linked source controls.
Per the 2021/2023 E/M revisions reflected in the MLN E/M Services Guide, a reporting practitioner may select the E/M level by total time spent on the date of the encounter — not just face-to-face time.
Time activities that count (when performed by the reporting practitioner on the date of the encounter, related to the encounter):
- Preparing to see the patient (reviewing tests)
- Obtaining and/or reviewing separately obtained history
- Performing a medically appropriate examination/evaluation
- Counseling and educating the patient/family/caregiver
- Ordering medications, tests, or procedures
- Referring and communicating with other healthcare professionals (when not separately reported)
- Documenting clinical information in the EHR
- Independently interpreting results (not separately reported) and communicating results
- Care coordination (not separately reported)
Activities that do not count: time spent by clinical staff, time on separately reportable services, time on a different day, travel, general teaching not specific to the patient.
Prolonged services (99417 for office visits; 99418 for inpatient) capture time above the highest level code (15-minute increments). The thresholds and reportability rules differ for Medicare vs. AMA CPT.
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Related regulations
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Related across the archive
- RegulationMLN: 2021 E/M Office Visit Coding RevisionsReference to the 2021 CPT E/M office visit (99202-99215) code revisions: history and exam no longer used for code selection; medical decision making or time controls.
- RegulationModifier 25: Significant, Separately Identifiable E/M ServiceModifier 25 is appended to an E/M code when the E/M is significant and separately identifiable from another procedure or service performed on the same day by the same provider.
- RegulationNCCI Chapter 11: Evaluation and Management ServicesNCCI policy on bundling and separately reporting E/M services with procedures, including modifier 25 use and global surgical package interactions.
- GlossaryE/M CodingEvaluation and Management codes (99202-99499) used to bill office, hospital, and other professional visits.
- Glossary99214 vs 99215The two most common established-patient office E/M levels; 99214 represents moderate complexity and 99215 high complexity.
- GlossaryCritical Care (99291-99292)CPT codes for evaluation and management of a critically ill or critically injured patient, time-based.
- GlossaryDocumentation CloningThe practice of copying prior or template-generated documentation into a new encounter note without updating it for the current visit.
- GlossaryDocumentation SpecificityThe level of detail in clinical documentation needed to support the diagnosis and service codes reported.
Last reviewed May 23, 2026 · Citation verified May 23, 2026
Research aid, not legal advice. This summary is an administrative research aid prepared by D3rx. It does not certify compliance, provide legal advice, replace counsel, or guarantee an audit outcome. For authoritative regulatory text follow the primary source link at the top of this page. The practice remains responsible for reviewing, adopting, and maintaining its compliance program.