Evaluation & Management Coding Optimization (E&M Coding)

Medicare billing codes, adoption data & revenue calculator

E&M codes (99211–99215) make up the largest share of Medicare billing for most practices. Many providers systematically under-code by defaulting to 99213 when documentation supports 99214 or 99215. Optimizing E&M coding can increase revenue by $15,000–$40,000 per provider per year.

Eligibility Criteria

Medical Decision Making (MDM) or total time determines E&M level
2021 guidelines eliminated history and exam as determining factors
99214 requires moderate complexity: 2+ chronic conditions or new problem with workup
99215 requires high complexity: severe exacerbation or threat to life/function

E&M Coding Billing Codes

Code	Description	Medicare Rate
99211	E&M — Level 1 (minimal problem, nurse visit)	$23.46
99212	E&M — Level 2 (straightforward MDM)	$57.68
99213	E&M — Level 3 (low MDM complexity)	$97.52
99214	E&M — Level 4 (moderate MDM complexity)	$143.52
99215	E&M — Level 5 (high MDM complexity)	$193.46

E&M Coding Resources

E&M Coding Billing Guide

Step-by-step billing guide with documentation requirements

Read guide

E&M Coding Revenue Calculator

Estimate your potential E&M Coding revenue

Calculate

E&M Coding Adoption Data

National adoption rates and trends

View data

Code Pages

Data: CMS Medicare Physician & Other Practitioners, 2024Last updated: January 2026

Scan a Evaluation & Management Coding Optimization Provider

Enter any Evaluation & Management Coding Optimization provider's NPI number to see their E&M coding patterns, program adoption, and revenue opportunities.

Run Free Scan