Billing

CMS Requirements for Billing

	99281	99282	99283	99284	99285
	Level1	Level 2	Level 3	Level 4	Level 5
HPI	1 of 8	1 of 8	1 of 8	4 of 8	4 of 8
ROS	0	1	1	2	10
PMHx, FamHx, Social Hx	0	0	0	1	2
PE	1	2	2	5	8
MDM	Straight‐forward	Low Complexity	Moderate Complexity	Moderate Complexity	High Complexity

• History of Present Present Illness Illness (HPI)
  • Location
  • Severity
  • Timing
  • Modifying Factors
  • Associated Associated Signs and Symptoms Symptoms
  • Onset
  • Quality
  • Duration

• Past Medical, Family, Family, Social History
  • Past Medical
    • Past Illnesses
    • Major Injuries
    • Surgical History
    • Hospitalizations
    • Immunizations
    • Feeding/Dietary
  • Family History
    • Health Status
    • Deaths
    • Hereditary Diseases
  • Social History
    • Drug, etoh , tobacco
    • Employment
    • Marital Status
    • Sexual History

RVU For Level of Service

• 99281 (Level 1) = 0.60 RVUs
• 99282 (Level 2) = 1.17 RVUs
• 99283 (Level 3) = 1.75 RVUs
• 99284 (Level 4) = 3.32 RVUs
• 99285 (Level 5) = 4.90 RVUs
• 99291 (Critical Care) = 6.31 RVUs 1st hr
  • Critical Critical care can be coded when the total duration duration of time spent by a provider in providing critical care services to a critically ill or critically injured patient is at least 30 minutes, even if the time spent is not continuous.