195
Total CPT Codes
171
Primary Codes
24
Add-on Codes
0
In Calculator
Category
Code Type
99213 primary
Low
Office/OP visit established - low MDM (20-29 min)
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day - Office/OP visit established - low MDM. Time: 20-29 minutes. 2+ stable chronic illnesses.
Evaluation & Management Primary code
Aetna: $75.28 Optum: $77.20
Eligible Add‑on Codes
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Office/OP visit established - low MDM. Time: 20-29 minutes. 2+ stable chronic illnesses.
99213 primary
Low
Office/OP visit established - low MDM (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day - Office/OP visit established - low MDM. Time: 20-29 minutes. 2+ stable chronic illnesses.
Evaluation & Management Primary code
Aetna: $75.28 Optum: $0.00
Eligible Add‑on Codes
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Office/OP visit established - low MDM. Time: 20-29 minutes. 2+ stable chronic illnesses.
99214 primary
Moderate
Office/OP visit established - moderate MDM (30-39 min)
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day - Office/OP visit established - moderate MDM. Time: 30-39 minutes. Chronic illness exacerbation, prescription management.
Evaluation & Management Primary code
Aetna: $110.60 Optum: $109.17
Eligible Add‑on Codes
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Office/OP visit established - moderate MDM. Time: 30-39 minutes. Chronic illness exacerbation, prescription management.
99214 primary
Moderate
Office/OP visit established - moderate MDM (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day - Office/OP visit established - moderate MDM. Time: 30-39 minutes. Chronic illness exacerbation, prescription management.
Evaluation & Management Primary code
Aetna: $110.60 Optum: $0.00
Eligible Add‑on Codes
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Office/OP visit established - moderate MDM. Time: 30-39 minutes. Chronic illness exacerbation, prescription management.
99215 primary
High
Office/OP visit established - high MDM (40-54 min)
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day - Office/OP visit established - high MDM. Time: 40-54 minutes. Severe exacerbation, hospitalization considered.
Evaluation & Management Primary code
Aetna: $148.12 Optum: $152.95
Eligible Add‑on Codes
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Office/OP visit established - high MDM. Time: 40-54 minutes. Severe exacerbation, hospitalization considered.
99215 primary
High
Office/OP visit established - high MDM (Non-Office)
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day - Office/OP visit established - high MDM. Time: 40-54 minutes. Severe exacerbation, hospitalization considered.
Evaluation & Management Primary code
Aetna: $148.12 Optum: $0.00
Eligible Add‑on Codes
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Office/OP visit established - high MDM. Time: 40-54 minutes. Severe exacerbation, hospitalization considered.
99217 primary
Moderate
Observation care discharge day management
Individual psychotherapy, 60 minutes (53+ minutes).
Per observation episode - Observation care discharge day management. Final assessment and discharge orders.
Evaluation & Management Primary code
Aetna: $74.87 Optum: $0.00
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Observation care discharge day management. Final assessment and discharge orders.
99218 primary
Low
Initial observation care - straightforward/low MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Per observation episode - Initial observation care - straightforward/low MDM. Admission to observation status.
Evaluation & Management Primary code
Aetna: $102.67 Optum: $0.00
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Initial observation care - straightforward/low MDM. Admission to observation status.
99219 primary
Moderate
Initial observation care - moderate MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Per observation episode - Initial observation care - moderate MDM. Moderate complexity observation admission.
Evaluation & Management Primary code
Aetna: $140.37 Optum: $0.00
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Initial observation care - moderate MDM. Moderate complexity observation admission.
99220 primary
High
Initial observation care - high MDM
Individual psychotherapy, 60 minutes (53+ minutes).
Per observation episode - Initial observation care - high MDM. High complexity observation admission.
Evaluation & Management Primary code
Aetna: $192.15 Optum: $0.00
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Initial observation care - high MDM. High complexity observation admission.
99221 primary
Low
Initial hospital care - low MDM (40 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per admission - Initial hospital care - low MDM. Time: 40 minutes. Stable patient, limited data review.
Evaluation & Management Primary code
Aetna: $128.75 Optum: $70.86
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Initial hospital care - low MDM. Time: 40 minutes. Stable patient, limited data review.
99222 primary
Moderate
Initial hospital care - moderate MDM (55 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per admission - Initial hospital care - moderate MDM. Time: 55 minutes. Multiple comorbidities, prescription management.
Evaluation & Management Primary code
Aetna: $143.23 Optum: $110.90
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Initial hospital care - moderate MDM. Time: 55 minutes. Multiple comorbidities, prescription management.
99223 primary
High
Initial hospital care - high MDM (75 min)
Individual psychotherapy, 60 minutes (53+ minutes).
Per admission - Initial hospital care - high MDM. Time: 75 minutes. Unstable patient, severe illness.
Evaluation & Management Primary code
Aetna: $210.78 Optum: $147.76
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Initial hospital care - high MDM. Time: 75 minutes. Unstable patient, severe illness.
99224 primary
Low
Subsequent observation care - straightforward/low MDM
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day - Subsequent observation care - straightforward/low MDM. Daily observation follow-up.
Evaluation & Management Primary code
Aetna: $41.45 Optum: $0.00
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Subsequent observation care - straightforward/low MDM. Daily observation follow-up.
99224 primary
Low
Subsequent observation care - straightforward/low MDM
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day - Subsequent observation care - straightforward/low MDM. Daily observation follow-up.
Evaluation & Management Primary code
Aetna: $41.45 Optum: $0.00
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Subsequent observation care - straightforward/low MDM. Daily observation follow-up.
99225 primary
Moderate
Subsequent observation care - moderate MDM
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day - Subsequent observation care - moderate MDM. Moderate complexity observation follow-up.
Evaluation & Management Primary code
Aetna: $74.88 Optum: $0.00
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Subsequent observation care - moderate MDM. Moderate complexity observation follow-up.
99226 primary
High
Subsequent observation care - high MDM
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day - Subsequent observation care - high MDM. High complexity observation follow-up.
Evaluation & Management Primary code
Aetna: $108.14 Optum: $0.00
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Subsequent observation care - high MDM. High complexity observation follow-up.
99231 primary
Low
Subsequent hospital care - low MDM (25 min)
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day - Subsequent hospital care - low MDM. Time: 25 minutes. Stable, recovering as expected.
Evaluation & Management Primary code
Aetna: $82.40 Optum: $42.34
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Subsequent hospital care - low MDM. Time: 25 minutes. Stable, recovering as expected.
99232 primary
Moderate
Subsequent hospital care - moderate MDM (35 min)
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day - Subsequent hospital care - moderate MDM. Time: 35 minutes. New finding, medication adjustment.
Evaluation & Management Primary code
Aetna: $82.40 Optum: $67.41
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Subsequent hospital care - moderate MDM. Time: 35 minutes. New finding, medication adjustment.
99233 primary
High
Subsequent hospital care - high MDM (50 min)
Individual psychotherapy, 60 minutes (53+ minutes).
1 per day - Subsequent hospital care - high MDM. Time: 50 minutes. Unstable, significant complication.
Evaluation & Management Primary code
Aetna: $107.42 Optum: $101.39
Documentation & MDM Details
  • Therapy duration: 53+ minutes documented
  • Moderate to high complexity: crisis intervention, trauma processing
  • Significant therapeutic content documented
  • Patient in acute distress or working through complex trauma
  • Detailed progress note with clinical formulation
MDM Checkpoints:
Complex presentation · Multiple data sources · Higher risk management
Frequency Note:
Subsequent hospital care - high MDM. Time: 50 minutes. Unstable, significant complication.
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