2018 E/M and Other Services Cheat Sheet
*Update: The 2021 OMFS updates drastically changed how E/M codes are billed.*
It’s that time of year: the DWC recently announced changes to the reimbursements for the Physician Fee Schedule. These reimbursement changes are effective for all dates of service on or after January 1, 2018.
Below are the new reimbursements for evaluation and management (E/M) services, as well as the most frequently-billed “Other” services. Next week, we’ll publish the reimbursement changes for the top surgery and radiology CPT codes.
Use the handy charts included in this blog for quick and easy reference, sign up for our webinar, and subscribe to DaisyBill’s Work Comp Wizard, which includes all of the reimbursement changes that take effect on January 1st.
Evaluation and Management (E/M) Services
Reimbursement for all E/M codes will be modestly higher, generally under 3%, with the exception of an 8.09% increase for CPT code 99211.
The table below lists each E/M code with the current reimbursement and the new reimbursement for 2018 with both the raw difference and difference in percentage.
Billing Code |
Description |
Reimbursement (Non-Facility) December 2017 |
Reimbursement (Non-Facility) January 2018 |
Reimbursement Difference |
Percent Change |
99202 |
Office/outpatient visit new |
$102.77 |
$104.53 |
$1.76 |
+1.68% |
99203 |
Office/outpatient visit new |
$147.37 |
$149.04 |
$1.67 |
+1.12% |
99204 |
Office/outpatient visit new |
$222.40 |
$225.94 |
$3.54 |
+1.57% |
99205 |
Office/outpatient visit new |
$279.16 |
$283.28 |
$4.12 |
+1.45% |
99211 |
Office/outpatient visit est |
$28.40 |
$30.90 |
$2.5 |
+8.09% |
99212 |
Office/outpatient visit est |
$60.39 |
$61.67 |
$1.28 |
+2.08% |
99213 |
Office/outpatient visit est |
$100.18 |
$101.39 |
$1.21 |
+1.19% |
99214 |
Office/outpatient visit est |
$147.02 |
$149.32 |
$2.30 |
+1.54% |
99215 |
Office/Outpatient Visit (est) |
$197.13 |
$200.52 |
$3.39 |
+1.69% |
99233 |
Subsequent Hospital Care |
$139.26 |
$140.73 |
$1.47 |
+1.04% |
Other Services
Reimbursement rates for various “other” services all increase, from just over a single percent, all the way up to a 12.11% increase for CPT code 95851 and a 17.02% jump for CPT code 95852, both for range of motion measurements.
Billing Code |
Description |
Reimbursement (Non-Facility) December 2017 |
Reimbursement (Non-Facility) January 2018 |
Reimbursement Difference |
Percent Change |
90837 |
Psytx w pt 60 minutes |
$166.71 |
$174.87 |
$8.16 |
+4.67% |
90875 |
Psychophysiological therapy |
$82.31 |
$84.79 |
$2.48 |
+2.92% |
95831 |
Limb muscle testing manual |
$43.81 |
$46.70 |
$2.89 |
+6.19% |
95832 |
Hand muscle testing manual |
$43.02 |
$45.61 |
$2.59 |
+5.68% |
95834 |
Body muscle testing manual |
$72.73 |
$76.82 |
$4.09 |
+5.32% |
95851 |
Range of motion measurements |
$25.40 |
$28.90 |
$3.50 |
+12.11% |
95852 |
Range of motion measurements |
$22.03 |
$26.55 |
$4.52 |
+17.02% |
95886 |
Musc test done w/n test comp |
$63.00 |
$63.74 |
$.74 |
+1.16% |
96101 |
Psycho testing by psych/phys |
$105.22 |
$110.60 |
$5.38 |
+4.86% |
98940 |
Chiropract manj 1-2 regions |
$38.61 |
$39.61 |
$1.00 |
+2.52% |
99354 |
Prolong e&m/psyctx serve o/p |
$173.90 |
$177.39 |
$3.49 |
+1.97% |
99358 |
Prolong service w/o contact |
$149.40 |
$150.99 |
$1.59 |
+1.05% |
99359 |
Prolong service w/o contact add |
$71.96 |
$72.74 |
$0.78 |
+1.07% |
Stay tuned to this blog for the rest of the 2018 OMFS updates, as well as news regarding changes to the authorization and utilization review process. Remember to sign up for our free webinar on 2018 OMFS changes as well. Together, we’ll hit the ground running in the new year.
We update our DaisyBill OMFS Calculator – one of the six products offered through our Work Comp Wizard – every time the Division of Workers’ Compensation (DWC) adjusts the workers’ comp fee schedule. That means that our clients never have to worry about outdated reimbursements.
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