CMS Updates their Evaluation & Management Booklet

The Center for Medicare & Medicaid Services (CMS) has made some significant changes to their Evaluation & Management Services Booklet. The following portions of the booklet have been changed to address new and revised policies:

• Office or Outpatient (O/O) Evaluation and Management (E/M) Visits

• Added information about 
• using O/O E/M visit add-on code G2211 with other services reported by the same practitioner on the same day
• billing intravitreal injections and E/M services using modifier 25

• Critical Care Services

• • Added examples and scenarios for billing critical care
  • Added a table for critical care billing situations

• Hospital Outpatient Clinic Visits

• • Added information about 
    • billing code G0463
    • using modifiers for off-campus provider-based departments

• Telehealth Services

• 2025 policy updates and changes
• Services and codes added to the Medicare Telehealth Services List for 2025

When reviewing this booklet, CMS has put the substantial content changes in dark red text for easy identification.

Be sure to review these changes and ensure that internal policies and procedures are revised to reflect these changes.

About Wyn Staheli, Director of Content - innoviHealth

Wyn Staheli is the Director of Content Research for innovHealth. She has over 30 years of experience in the healthcare industry. With her degree in Management Information Systems (MIS), she has been a programmer for a large insurance carrier as well as a California hospital system. She is also the author and editor of many medical resource books and the founder of InstaCode Institute.