2018 E/M and Other Services Cheat Sheet

December 15, 2017 3 min read

By: Catherine Montgomery

*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.

Sign up below for a free trial of the Work Comp Wizard.

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