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Chiropractors: 99201 Deleted effective 01/01/2021

Procedure code 99201 (Office or Other Outpatient Visit, New Patient, low level) has been deleted effective 01/01/2021. The range of new patient codes in the 2021 CPT book are 99202-99205.

Additionally, guidelines for code selection of outpatient evaluation and management (E&M) services have changed effective 2021. The main difference is that code selection of these services uses medical decision making or time. These guidelines do not establish documentation requirements of standards of care. History and examination should still be completed and documented, as medically appropriate.

Please be aware that if basing code selection on time, medical necessity must still be supported in the medical record or the services may be denied or reduced. Time must also be documented in the medical record.

Modifier 25 should not be used when billing new patient E/M codes.  Reimbursement will be reduced to 75 percent of the maximum allowable payment (MAP) on the service billed with modifier 25.

Please remember that established E&M codes should not be billed in conjunction with any manipulations. Routine use of E&M codes without sufficient documentation is not an appropriate billing practice. Re-evaluation will deny content of service to the manipulation. Use of modifier 25 will not allow the E&M service to pay.

If you have questions regarding this publication, please contact your BCBSKS provider representative.

Professional Providers