Interventional Spine Trainer

billing

E/M Codes for Pain Management

Code	Description	Typical Time	MDM Level	Documentation Requirements
99202	New patient, straightforward	15-29 min	Straightforward	Minimal problems; minimal/no data; minimal risk of complications
99203	New patient, low complexity	30-44 min	Low	2+ self-limited problems OR 1 chronic illness; limited data review; low risk (e.g., OTC meds)
99204	New patient, moderate complexity	45-59 min	Moderate	1+ chronic illness with exacerbation OR 2+ stable chronic; moderate data (order/review tests, external records); Rx drug management
99205	New patient, high complexity	60-74 min	High	1+ chronic illness with severe exacerbation OR acute threat to life; extensive data; high risk (drug therapy requiring intensive monitoring, decision about hospitalization)
99212	Established patient, straightforward	10-19 min	Straightforward	Minimal problems; minimal/no data; minimal risk
99213	Established patient, low complexity	20-29 min	Low	2+ self-limited problems OR 1 stable chronic; limited data; low risk
99214	Established patient, moderate complexity	30-39 min	Moderate	1+ chronic illness with exacerbation; moderate data review; Rx drug management. Most common established pain visit.
99215	Established patient, high complexity	40-54 min	High	1+ chronic illness with severe exacerbation; extensive data; high risk decisions. Complex pain patients with multiple comorbidities.
99417	Prolonged services (commercial)	Each 15 min beyond 99205/99215	N/A (time-based)	Only added to 99205 or 99215; document exact total time; must exceed base code threshold by >= 15 min
G2212	Prolonged services (Medicare)	Each 15 min beyond 99205/99215	N/A (time-based)	Medicare equivalent of 99417 (99417 has status 'I' on Medicare fee schedule); document exact total time

Notes

1. Modifier -25: append to E/M code when a separately identifiable E/M is performed on the same day as a procedure. The evaluation must be distinct from the pre-procedure assessment.
2. Same-day procedure billing: bill E/M-25 + procedure code. Example: 99214-25 + 64483 for follow-up visit with medication adjustment + lumbar TFESI.
3. E/M coding can be based on either total time OR medical decision-making (MDM) -- use whichever supports the higher level.
4. If using time-based coding, document exact start and stop times for the encounter.
5. 99417/G2212 can only be added to the highest-level codes (99205 new or 99215 established); they are not valid add-ons to lower-level E/M codes.

Source: CMS, AMA CPT 2025-2026 | Updated: 2026-04-03