BMI Encounter Code Set (1295)    NLM VALUE SETS (802.2)

Interactive individual medical psychotherapy (regime/therapy)

Examination of breast (procedure)

Tooth extraction (procedure)

Surgical removal of erupted tooth requiring elevation of mucoperiosteal 
flap and removal of bone and/or section of tooth (procedure)

History and physical examination, annual for health maintenance (procedure)

Gynecologic examination (procedure)

Periodic reevaluation and management of healthy individual (procedure)

Initial evaluation and management of healthy individual (procedure)

Evaluation AND/OR management - new patient (procedure)

Evaluation AND/OR management - established patient (procedure)

Preventive patient evaluation (procedure)

Psychiatric interview and evaluation (procedure)

Psychiatric procedure, interview AND/OR consultation (procedure)

Initial psychiatric evaluation (procedure)

Encounter for "check-up" (procedure)

Visit out of hours (procedure)

Weekend visit (procedure)

Self-care patient education (procedure)

Patient-initiated encounter (procedure)

Provider-initiated encounter (procedure)

Patient encounter procedure (procedure)

Nutrition management (regime/therapy)

Manual examination of breast (procedure)

Follow-up encounter (procedure)

Urgent follow-up (procedure)

Occupational therapy assessment (procedure)

Occupational therapy management (procedure)

Physical therapy assessment (procedure)

Physical therapy management (procedure)

Nutrition care assessment (procedure)

Nutrition care management (procedure)

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

Individual psychotherapy (regime/therapy)

Evaluation and management of established outpatient in office or other 
outpatient facility (procedure)

Psychiatric diagnostic interview, examination, history, mental status and 
disposition (procedure)

Manual pelvic examination (procedure)

Evaluation and management of new outpatient in office or other outpatient 
facility (procedure)

Psychiatric diagnostic evaluation

Occupational therapy evaluation

Medical nutrition therapy; initial assessment and intervention, individual, 
face-to-face with the patient, each 15 minutes

Medical nutrition therapy; re-assessment and intervention, individual, 
face-to-face with the patient, each 15 minutes

Education and training for patient self-management by a qualified, nonphysician 
health care professional using a standardized curriculum, face-to-face 
with the patient (could include caregiver/family) each 30 minutes; individual 
patient

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 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.

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.

Psychiatric diagnostic evaluation with medical services

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.

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

Psychotherapy, 30 minutes with patient and/or family member

Psychotherapy, 45 minutes with patient and/or family member

Psychotherapy, 60 minutes with patient and/or family member

Health and behavior assessment (eg, health-focused clinical interview, 
behavioral observations, psychophysiological monitoring, health-oriented 
questionnaires), each 15 minutes face-to-face with the patient; initial 
assessment

Health and behavior assessment (eg, health-focused clinical interview, 
behavioral observations, psychophysiological monitoring, health-oriented 
questionnaires), each 15 minutes face-to-face with the patient; re-assessment

Health and behavior intervention, each 15 minutes, face-to-face; individual

Physical therapy evaluation

Cervical or vaginal cancer screening; pelvic and clinical breast examination

Diabetes outpatient self-management training services, individual, per 
30 minutes

Medical nutrition therapy; reassessment and subsequent intervention(s) 
following second referral in same year for change in diagnosis, medical 
condition or treatment regimen (including additional hours needed for renal 
disease), individual, face to face with the patient, each 15 minutes

Medical nutrition therapy, reassessment and subsequent intervention(s) 
following second referral in same year for change in diagnosis, medical 
condition, or treatment regimen (including additional hours needed for 
renal disease), group (2 or more individuals), each 30 minutes

Initial preventive physical examination; face-to-face visit, services limited 
to new beneficiary during the first 12 months of medicare enrollment

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

Face-to-face behavioral counseling for obesity, 15 minutes

extraction, erupted tooth or exposed root (elevation and/or forceps removal)

surgical removal of erupted tooth requiring removal of bone and/or sectioning 
of tooth, and including elevation of mucoperiosteal flap if indicated