Free tool · 2026 E/M guidelines

E/M audit tool 2026

Score an office visit by MDM or time, check it against the billed code, and catch add-on and modifier errors before the payer does.

1 · Visit details

Office or other outpatient visit (99202–99215).

Patient type

Payer

Billed code

Modifier 25 (procedure same day)Billing G2211Longitudinal care add-on

2 · Number and complexity of problems addressed

Count only problems addressed at this visit — not every diagnosis on the problem list.

Highest level documented

Minimal1 self-limited or minor problemLow2+ minor problems; 1 stable chronic illness; 1 acute uncomplicated illness or injury; 1 stable acute illnessModerate1+ chronic illness with exacerbation, progression or side effects; 2+ stable chronic illnesses; 1 undiagnosed new problem with uncertain prognosis; 1 acute illness with systemic symptoms; 1 acute complicated injuryHigh1+ chronic illness with severe exacerbation, progression or side effects; 1 acute or chronic illness or injury that poses a threat to life or bodily function

3 · Data reviewed and analyzed

Each unique test counts once. Ordering a test includes reviewing its result — don’t count both.

External notes reviewed

Each unique source

Test results reviewed

Each unique test

Tests ordered

Each unique test

Independent historiane.g. parent, caregiver, EMSIndependent interpretation of a testPerformed by another provider, not separately billedDiscussion of management with external physician/QHPOr appropriate source; not separately billed

Data level: Straightforward — minimal or no data

4 · Risk of complications from patient management

Highest risk documented

Minimale.g. rest, gargles, bandages, OTC adviceLowe.g. OTC drug management, minor surgery without risk factors, PT/OTModeratee.g. prescription drug management; minor surgery with risk factors; elective major surgery without risk factors; care significantly limited by social determinants of healthHighe.g. drug therapy needing intensive toxicity monitoring; elective major surgery with risk factors; emergency major surgery; decision about hospitalization or escalation; DNR / de-escalation due to poor prognosis; parenteral controlled substances

5 · Total time (optional)

Use when time gives a higher level than MDM. Total practitioner time on the date of the encounter.

Time is documented in the noteTotal minutes

Level	New	Min	Est.	Min
Straightforward	99202	15+	99212	10+
Low	99203	30+	99213	20+
Moderate	99204	45+	99214	30+
High	99205	60+	99215	40+

Reference tool only, based on the office/outpatient E/M guidelines in effect for 2026 and CMS Medicare rules. It doesn’t replace a certified coder’s review or payer policy. CPT® is a registered trademark of the American Medical Association. For the full rules, read our E/M coding guidelines 2026.

How it works

Audit an E/M visit in under a minute

Score MDM

Pick the highest level documented for problems and risk, and count data items. The tool applies the 2-of-3 rule automatically.

Or use time

Enter total practitioner time on the date of service. The higher of MDM or time sets the supported level.

Compare to billed

See whether the billed code is supported, overcoded, or undercoded — and exactly which element is missing.

Check add-ons

Flags G2211 with modifier 25, Medicare G2212 vs. CPT 99417 timing, and new vs. established patient errors.

FAQ

About the E/M audit tool

Which E/M codes does the tool cover?

Office and other outpatient visits: 99202–99205 for new patients and 99211–99215 for established patients. 99211 is shown for reference because it is not scored by MDM or time.

How is the MDM level calculated?

MDM has three elements: problems addressed, data reviewed and analyzed, and risk of patient management. The visit level is the highest level met or exceeded by at least two of the three.

What are the 2026 time thresholds for office visits?

New patients: 99202 15 minutes, 99203 30, 99204 45, 99205 60. Established patients: 99212 10 minutes, 99213 20, 99214 30, 99215 40. Time is total practitioner time on the date of the encounter.

When do I bill 99417 vs. G2212?

Both are prolonged-service add-ons for 99205 and 99215 billed by time. CPT payers use 99417 starting at 75 minutes (new) or 55 minutes (established). Medicare uses G2212 starting at 89 minutes (new) or 69 minutes (established). Each additional full 15 minutes adds a unit.

Can G2211 be billed with modifier 25?

For Medicare, generally no. The exception is when the other same-day service is an annual wellness visit, vaccine administration, or a Medicare Part B preventive service.

Is it safe to use with real encounters?

Yes. The tool runs entirely in your browser and stores nothing. Don’t enter patient names or identifiers — none are needed.

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