Understanding the 2021 Evaluation and Management (E/M) Changes

This page summarizes the E/M coding changes that go into effect January 1, 2021. These changes affect billing for in-office services for Medicare and non-Medicare patients. These changes do not apply to care provided in such settings as hospitals or nursing homes. If you see patients in settings outside of your office, continue to use 1997 coding criteria for those encounters.

The content in this section is informational only. It is intended to help you understand how to document E/M codes in Eyefinity software. This content is not intended to provide coding advice or guidance. For guidance or clarification about the appropriate application of E/M codes, refer to your state optometric association or

In addition to the E/M coding and guideline changes, AMA and CMS adopted revisions to the CPT code set. For example, the 99201 E/M code has been retired. For more information, go to 2021 CPT Code Updates.

The E/M code and guideline changes were proposed by the American Medical Association (AMA) and adopted as part of CMS’ Patients over Paperwork initiative. These changes are intended to reduce the burden of E/M documentation and reduce provider burnout.

One example of reducing the burden of documentation is the elimination of the history and physical as elements for code selection. Instead, the provider may determine the nature and extent to which the patient’s history and physical exam factored into the complexity of medical decision making.

The following table represents a snapshot of the differences between the E/M coding guidance prior to January 1, 2021, and after January 1, 2021.

  Pre-2021 2021 E/M Rules

New Patients

  • History
  • Physical Exam
  • Medical decision making
  • Time or medical decision making

Established Patients

  • History or physical exam
  • Medical decision making
  • Time or medical decision making

Eyefinity customer care cannot help you code your exams or run through what-if scenarios. If you're looking for a clinician's perspective on the 2021 E/M coding and guidelines, watch this AOA webinar recording.

Finding Additional Information

This section also includes the following topics: