Adult Outpatient Visit (1245)    NLM VALUE SETS (802.2)

Subsequent hospital visit by physician (procedure)

Patient-initiated encounter (procedure)

Provider-initiated encounter (procedure)

Patient encounter procedure (procedure)

Follow-up encounter (procedure)

Urgent follow-up (procedure)

Home visit (procedure)

Subsequent nursing facility visit (procedure)

Nursing evaluation of patient and report (procedure)

Follow-up inpatient consultation visit (procedure)

Initial evaluation and management of healthy individual (procedure)

Encounter for "check-up" (procedure)

Visit out of hours (procedure)

Weekend visit (procedure)

History and physical examination with evaluation and management of nursing 
facility patient (procedure)

Office or other outpatient visit for the evaluation and management of a 
new patient, which requires these 3 key components: A problem focused history; 
A problem focused examination; Straightforward medical decision making. 
Counseling and/or coordination of care with other physicians, other qualified 
health care professionals, or agencies are provided consistent with the 
nature of the problem(s) and the patient's and/or family's needs. Usually, 
the presenting problem(s) are self limited or minor. Typically, 10 minutes 
are spent face-to-face with the patient and/or family.

Office consultation for a new or established patient, which requires these 
3 key components: A problem focused history; A problem focused examination; 
and Straightforward medical decision making. Counseling and/or coordination 
of care with other physicians, other qualified health care professionals, 
or agencies are provided consistent with the nature of the problem(s) and 
the patient's and/or family's needs. Usually, the presenting problem(s) 
are self limited or minor. Typically, 15 minutes are spent face-to-face 
with the patient and/or family.

Office consultation for a new or established patient, which requires these 
3 key components: An expanded problem focused history; An expanded problem 
focused examination; and Straightforward medical decision making. Counseling 
and/or coordination of care with other physicians, other qualified health 
care professionals, or agencies are provided consistent with the nature 
of the problem(s) and the patient's and/or family's needs. Usually, the 
presenting problem(s) are of low severity. Typically, 30 minutes are spent 
face-to-face with the patient and/or family.

Office consultation for a new or established patient, which requires these 
3 key components: A detailed history; A detailed examination; and Medical 
decision making of low complexity. Counseling and/or coordination of care 
with other physicians, other qualified health care professionals, or agencies 
are provided consistent with the nature of the problem(s) and the patient's 
and/or family's needs. Usually, the presenting problem(s) are of moderate 
severity. Typically, 40 minutes are spent face-to-face with the patient 
and/or family.

Office consultation for a new or established patient, which requires these 
3 key components: A comprehensive history; A comprehensive examination; 
and Medical decision making of moderate complexity. Counseling and/or coordination 
of care with other physicians, other qualified health care professionals, 
or agencies are provided consistent with the nature of the problem(s) and 
the patient's and/or family's needs. Usually, the presenting problem(s) 
are of moderate to high severity. Typically, 60 minutes are spent face-to-face 
with the patient and/or family.

Office consultation for a new or established patient, which requires these 
3 key components: A comprehensive history; A comprehensive examination; 
and Medical decision making of high complexity. Counseling and/or coordination 
of care with other physicians, other qualified health care professionals, 
or agencies are provided consistent with the nature of the problem(s) and 
the patient's and/or family's needs. Usually, the presenting problem(s) 
are of moderate to high severity. Typically, 80 minutes are spent face-to-face 
with the patient and/or family.

Home visit for the evaluation and management of a new patient, which requires 
these 3 key components: A problem focused history; A problem focused examination; 
and Straightforward medical decision making. Counseling and/or coordination 
of care with other physicians, other qualified health care professionals, 
or agencies are provided consistent with the nature of the problem(s) and 
the patient's and/or family's needs. Usually, the presenting problem(s) 
are of low severity. Typically, 20 minutes are spent face-to-face with 
the patient and/or family.

Home visit for the evaluation and management of a new patient, which requires 
these 3 key components: An expanded problem focused history; An expanded 
problem focused examination; and Medical decision making of low complexity. 
Counseling and/or coordination of care with other physicians, other qualified 
health care professionals, or agencies are provided consistent with the 
nature of the problem(s) and the patient's and/or family's needs. Usually, 
the presenting problem(s) are of moderate severity. Typically, 30 minutes 
are spent face-to-face with the patient and/or family.

Home visit for the evaluation and management of a new patient, which requires 
these 3 key components: A detailed history; A detailed examination; and 
Medical decision making of moderate complexity. Counseling and/or coordination 
of care with other physicians, other qualified health care professionals, 
or agencies are provided consistent with the nature of the problem(s) and 
the patient's and/or family's needs. Usually, the presenting problem(s) 
are of moderate to high severity. Typically, 45 minutes are spent face-to-face 
with the patient and/or family.

Home visit for the evaluation and management of a new patient, which requires 
these 3 key components: A comprehensive history; A comprehensive examination; 
and Medical decision making of moderate complexity. Counseling and/or coordination 
of care with other physicians, other qualified health care professionals, 
or agencies are provided consistent with the nature of the problem(s) and 
the patient's and/or family's needs. Usually, the presenting problem(s) 
are of high severity. Typically, 60 minutes are spent face-to-face with 
the patient and/or family.

Home visit for the evaluation and management of a new patient, which requires 
these 3 key components: A comprehensive history; A comprehensive examination; 
and Medical decision making of high complexity. Counseling and/or coordination 
of care with other physicians, other qualified health care professionals, 
or agencies are provided consistent with the nature of the problem(s) and 
the patient's and/or family's needs. Usually, the patient is unstable or 
has developed a significant new problem requiring immediate physician attention. 
Typically, 75 minutes are spent face-to-face with the patient and/or family.

Office or other outpatient visit for the evaluation and management of a 
new patient, which requires these 3 key components: An expanded problem 
focused history; An expanded problem focused examination; Straightforward 
medical decision making. Counseling and/or coordination of care with other 
physicians, other qualified health care professionals, or agencies are 
provided consistent with the nature of the problem(s) and the patient's 
and/or family's needs. Usually, the presenting problem(s) are of low to 
moderate severity. Typically, 20 minutes are spent face-to-face with the 
patient and/or family.

Home visit for the evaluation and management of an established patient, 
which requires at least 2 of these 3 key components: A problem focused 
interval history; A problem focused examination; Straightforward medical 
decision making. Counseling and/or coordination of care with other physicians, 
other qualified health care professionals, or agencies are provided consistent 
with the nature of the problem(s) and the patient's and/or family's needs. 
Usually, the presenting problem(s) are self limited or minor. Typically, 
15 minutes are spent face-to-face with the patient and/or family.

Home visit for the evaluation and management of an established patient, 
which requires at least 2 of these 3 key components: An expanded problem 
focused interval history; An expanded problem focused examination; Medical 
decision making of low complexity. Counseling and/or coordination of care 
with other physicians, other qualified health care professionals, or agencies 
are provided consistent with the nature of the problem(s) and the patient's 
and/or family's needs. Usually, the presenting problem(s) are of low to 
moderate severity. Typically, 25 minutes are spent face-to-face with the 
patient and/or family.

Home visit for the evaluation and management of an established patient, 
which requires at least 2 of these 3 key components: A detailed interval 
history; A detailed examination; Medical decision making of moderate complexity. 
Counseling and/or coordination of care with other physicians, other qualified 
health care professionals, or agencies are provided consistent with the 
nature of the problem(s) and the patient's and/or family's needs. Usually, 
the presenting problem(s) are moderate to high severity. Typically, 40 
minutes are spent face-to-face with the patient and/or family.

Home visit for the evaluation and management of an established patient, 
face-to-face with the patient and/or family.
which requires at least 2 of these 3 key components: A comprehensive interval 
history; A comprehensive examination; Medical decision making of moderate 
to high complexity. Counseling and/or coordination of care with other physicians, 
other qualified health care professionals, or agencies are provided consistent 
with the nature of the problem(s) and the patient's and/or family's needs. 
Usually, the presenting problem(s) are of moderate to high severity. The 
patient may be unstable or may have developed a significant new problem 
requiring immediate physician attention. Typically, 60 minutes are spent 

Initial comprehensive preventive medicine evaluation and management of 
an individual including an age and gender appropriate history, examination, 
counseling/anticipatory guidance/risk factor reduction interventions, and 
the ordering of laboratory/diagnostic procedures, new patient; 18-39 years

Initial comprehensive preventive medicine evaluation and management of 
an individual including an age and gender appropriate history, examination, 
counseling/anticipatory guidance/risk factor reduction interventions, and 
the ordering of laboratory/diagnostic procedures, new patient; 40-64 years

Initial comprehensive preventive medicine evaluation and management of 
an individual including an age and gender appropriate history, examination, 
counseling/anticipatory guidance/risk factor reduction interventions, and 
the ordering of laboratory/diagnostic procedures, new patient; 65 years 
and older

Periodic comprehensive preventive medicine reevaluation and management 
of an individual including an age and gender appropriate history, examination, 
counseling/anticipatory guidance/risk factor reduction interventions, and 
the ordering of laboratory/diagnostic procedures, established patient; 
18-39 years

Periodic comprehensive preventive medicine reevaluation and management 
of an individual including an age and gender appropriate history, examination, 
counseling/anticipatory guidance/risk factor reduction interventions, and 
the ordering of laboratory/diagnostic procedures, established patient; 
40-64 years

Periodic comprehensive preventive medicine reevaluation and management 
of an individual including an age and gender appropriate history, examination, 
counseling/anticipatory guidance/risk factor reduction interventions, and 
the ordering of laboratory/diagnostic procedures, established patient; 
65 years and older

Office or other outpatient visit for the evaluation and management of a 
new patient, which requires these 3 key components: A detailed history; 
A detailed examination; Medical decision making of low complexity. Counseling 
and/or coordination of care with other physicians, other qualified health 
care professionals, or agencies are provided consistent with the nature 
of the problem(s) and the patient's and/or family's needs. Usually, the 
presenting problem(s) are of moderate severity. Typically, 30 minutes are 
spent face-to-face with the patient and/or family.

Office or other outpatient visit for the evaluation and management of a 
new patient, which requires these 3 key components: A comprehensive history; 
A comprehensive examination; Medical decision making of moderate complexity. 
Counseling and/or coordination of care with other physicians, other qualified 
health care professionals, or agencies are provided consistent with the 
nature of the problem(s) and the patient's and/or family's needs. Usually, 
the presenting problem(s) are of moderate to high severity. Typically, 
45 minutes are spent face-to-face with the patient and/or family.

Office or other outpatient visit for the evaluation and management of a 
new patient, which requires these 3 key components: A comprehensive history; 
A comprehensive examination; Medical decision making of high complexity. 
Counseling and/or coordination of care with other physicians, other qualified 
health care professionals, or agencies are provided consistent with the 
nature of the problem(s) and the patient's and/or family's needs. Usually, 
the presenting problem(s) are of moderate to high severity. Typically, 
60 minutes are spent face-to-face with the patient and/or family.

Office or other outpatient visit for the evaluation and management of an 
established patient, which requires at least 2 of these 3 key components: 
A problem focused history; A problem focused examination; Straightforward 
medical decision making. Counseling and/or coordination of care with other 
physicians, other qualified health care professionals, or agencies are 
provided consistent with the nature of the problem(s) and the patient's 
and/or family's needs. Usually, the presenting problem(s) are self limited 
or minor. Typically, 10 minutes are spent face-to-face with the patient 
and/or family.

Office or other outpatient visit for the evaluation and management of an 
established patient, which requires at least 2 of these 3 key components: 
An expanded problem focused history; An expanded problem focused examination; 
Medical decision making of low complexity. Counseling and coordination 
of care with other physicians, other qualified health care professionals, 
or agencies are provided consistent with the nature of the problem(s) and 
the patient's and/or family's needs. Usually, the presenting problem(s) 
are of low to moderate severity. Typically, 15 minutes are spent face-to-face 
with the patient and/or family.

Office or other outpatient visit for the evaluation and management of an 
established patient, which requires at least 2 of these 3 key components: 
A detailed history; A detailed examination; Medical decision making of 
moderate complexity. Counseling and/or coordination of care with other 
physicians, other qualified health care professionals, or agencies are 
provided consistent with the nature of the problem(s) and the patient's 
and/or family's needs. Usually, the presenting problem(s) are of moderate 
to high severity. Typically, 25 minutes are spent face-to-face with the 
patient and/or family.

Office or other outpatient visit for the evaluation and management of an 
established patient, which requires at least 2 of these 3 key components: 
A comprehensive history; A comprehensive examination; Medical decision 
making of high complexity. Counseling and/or coordination of care with 
other physicians, other qualified health care professionals, or agencies 
are provided consistent with the nature of the problem(s) and the patient's 
and/or family's needs. Usually, the presenting problem(s) are of moderate 
to high severity. Typically, 40 minutes are spent face-to-face with the 
patient and/or family.

Annual wellness visit; includes a personalized prevention plan of service 
(pps), initial visit

Annual wellness visit, includes a personalized prevention plan of service 
(pps), subsequent visit