Unraveling the 2023 CPT Code Changes: A Closer Look at Deleted Codes 99354-99355, 99241, 99251, 99318, 99339, and 99340
Stay informed about 2023 CPT code changes and their impact on medical billing, coding accuracy and compliance.
- Consultation Code Streamlining: Lowest-level consultation codes (99241 and 99251) were permanently deleted to align with 2021 outpatient E/M MDM scoring principles.
- Prolonged Services Shift: Direct-contact prolonged codes (99354–99355) were sunset in favor of add-on time codes (CPT 99417 for commercial payers and HCPCS G2212 for Medicare).
- Home & Residence Care Merger: Domiciliary and rest home codes (99324–99340) merged into unified Home or Residence Service codes (99341–99350).
- MDM or Total Time: All non-office E/M encounters (inpatient, observation, nursing facility, home) now select code level solely based on Medical Decision Making or total encounter time.
The landmark Evaluation and Management (E/M) revisions enacted by the American Medical Association (AMA) and adopted by the Centers for Medicare & Medicaid Services (CMS) represented a structural modernization across all clinical care settings. Following the 2021 office visit reforms, the 2023 updates eliminated historical documentation burdens across inpatient, observation, emergency department, nursing facility, and home care environments.
A central pillar of these revisions was the targeted deletion of obsolete Current Procedural Terminology (CPT) codes—specifically 99354-99355, 99241, 99251, 99318, 99339, and 99340. Understanding how these deletions impact clinical documentation and code selection is essential for maintaining revenue integrity. Here is Shoreline Medical Billing's comprehensive analysis.
The E/M Overhaul: Streamlining Consultation Codes
Historically, outpatient consultations (99241–99245) and inpatient consultations (99251–99255) included level 1 codes that were virtually never utilized due to their low clinical complexity thresholds. The AMA officially deleted CPT codes 99241 and 99251:
- Revised Outpatient Consultation Range: Practices now report 99242 through 99245, selecting code levels based either on Medical Decision Making (Straightforward, Low, Moderate, or High) or cumulative total physician time on the date of encounter.
- Revised Inpatient Consultation Range: Inpatient consultations now span 99252 through 99255, harmonized with identical MDM level definitions across all acute hospital environments.
- Consultation Transfer of Care Rules: Coders must ensure documentation explicitly confirms a written request from the referring clinician, a diagnostic evaluation, and a written report returned to the requesting provider. If care is transferred, standard initial inpatient or outpatient visit codes must be billed instead.
Prolonged Services Restructuring: Deletion of 99354–99355
Direct-contact prolonged services codes (CPT 99354 and 99355) were sunset to resolve long-standing billing confusion between direct face-to-face time and total date-of-encounter time:
- Commercial Payer Guidelines (CPT 99417): When billing commercial health plans, prolonged service add-on code 99417 is reported for each 15-minute increment beyond the minimum time threshold of the primary highest-level visit code (e.g., 99205, 99215, 99223).
- Medicare Guidelines (HCPCS G2212 & G0316): CMS does not recognize CPT 99417 for office visits. Instead, Medicare Part B requires HCPCS code G2212 for office prolonged visits and G0316 for inpatient/observation prolonged encounters once total encounter time exceeds the maximum time published by CMS by at least 15 minutes.
- Clinical Documentation Threshold: Physician encounter notes must meticulously record total minutes spent on non-face-to-face and face-to-face care on the encounter date to survive audit scrutiny.
Nursing Facility & Home Residence Care Realignment
Care delivered outside hospital walls also underwent significant consolidation to eliminate redundant coding tracks:
- Annual Nursing Assessment Sunset (99318): Annual assessments in skilled nursing facilities (SNF) are now reported using standard nursing facility subsequent care codes (99307–99310), categorizing services by MDM severity rather than visit chronology.
- Unified Home or Residence Services (99341–99350): The historical distinction between private home visits and rest home / assisted living / domiciliary facilities (formerly codes 99324–99340) was eliminated. All home and residence care now utilizes the 99341–99350 code series.
- Removal of Extraneous History & Exam Tallies: Clinicians are no longer required to document arbitrary counts of body systems reviewed. Only a medically appropriate history and physical examination is required, shifting coding determination entirely to MDM or time.
Practice Audit Playbook for Post-2023 CPT Compliance
Shoreline Medical Billing recommends healthcare organizations conduct focused retrospective chart reviews to confirm compliance with these modernized coding standards:
- Deactivate Deleted Codes in PM/EHR: Ensure practice management charge capture super-bills have permanently disabled retired codes (99241, 99251, 99354, 99355, 99318) to avoid clearinghouse rejections.
- Payer Rule Configuration: Configure automated billing rules that crosswalk prolonged service codes appropriately between commercial plans (CPT 99417) and Medicare Part B (HCPCS G2212/G0316).
- Provider MDM Training: Educate clinical staff on the 2023 Medical Decision Making table, emphasizing the three core elements: Number and Complexity of Problems Addressed, Amount and Complexity of Data to be Reviewed, and Risk of Complications or Morbidity.
Partnering with Shoreline Medical Billing provides your practice with certified AAPC/AHIMA coding professionals who protect your cash flow and ensure 100% compliance with ongoing AMA and CMS coding modifications.
