BP Screening Encounter Codes (1298)    NLM VALUE SETS (802.2)

Emergency department patient visit (procedure)

Evaluation and management of patient at home (procedure)

Hospital admission, for observation (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)

Patient status observation (procedure)

Evaluation AND/OR management - new patient (procedure)

Evaluation AND/OR management - established patient (procedure)

Preventive patient evaluation (procedure)

Subsequent hospital visit by physician (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)

History and physical examination with management of domiciliary or rest 
home patient (procedure)

Domiciliary or rest home patient evaluation and management (procedure)

Patient-initiated encounter (procedure)

Provider-initiated encounter (procedure)

Discharge from day hospital (procedure)

Patient encounter procedure (procedure)

Manual examination of breast (procedure)

Follow-up encounter (procedure)

Urgent follow-up (procedure)

Home visit (procedure)

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

Subsequent nursing facility visit (procedure)

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

Manual pelvic examination (procedure)

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

Examination of breast (procedure)

Psychiatric diagnostic evaluation

Ophthalmological services: medical examination and evaluation with initiation 
of diagnostic and treatment program; comprehensive, new patient, 1 or more 
visits

Ophthalmological services: medical examination and evaluation, with initiation 
or continuation of diagnostic and treatment program; intermediate, established 
patient

Ophthalmological services: medical examination and evaluation, with initiation 
or continuation of diagnostic and treatment program; comprehensive, established 
patient, 1 or more visits

Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, 
Wechsler Memory Scales and Wisconsin Card Sorting Test), per hour of the 
psychologist's or physician's time, both face-to-face time administering 
tests to the patient and time interpreting these test results and preparing 
the report

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.

Emergency department visit for the evaluation and management of a 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.

Emergency department visit for the evaluation and management of a 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 low to moderate severity.

Emergency department visit for the evaluation and management of a patient, 
which requires these 3 key components: An expanded problem focused history; 
An expanded problem focused 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 
severity.

Emergency department visit for the evaluation and management of a 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 high severity, and require urgent evaluation by the physician, or 
other qualified health care professionals but do not pose an immediate 
significant threat to life or physiologic function.

Emergency department visit for the evaluation and management of a patient, 
which requires these 3 key components within the constraints imposed by 
the urgency of the patient's clinical condition and/or mental status: 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 high severity 
and pose an immediate significant threat to life or physiologic function.

Initial nursing facility care, per day, for the evaluation and management 
of a patient, which requires these 3 key components: A detailed or comprehensive 
history; A detailed or comprehensive examination; and Medical decision 
making that is straightforward or 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 problem(s) 
requiring admission are of low severity. Typically, 25 minutes are spent 
at the bedside and on the patient's facility floor or unit.

Initial nursing facility care, per day, for the evaluation and management 
of a 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 problem(s) requiring admission are of moderate severity. Typically, 
35 minutes are spent at the bedside and on the patient's facility floor 
or unit.

Psychotherapy, 30 minutes with patient and/or family member

Initial nursing facility care, per day, for the evaluation and management 
of a 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 problem(s) requiring admission are of high severity. Typically, 45 
minutes are spent at the bedside and on the patient's facility floor or 
unit.

Subsequent nursing facility care, per day, for the evaluation and management 
of a 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 patient is stable, recovering, or improving. 
Typically, 10 minutes are spent at the bedside and on the patient's facility 
floor or unit.

Subsequent nursing facility care, per day, for the evaluation and management 
or unit.
of a 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 patient is responding 
inadequately to therapy or has developed a minor complication. Typically, 
15 minutes are spent at the bedside and on the patient's facility floor 

Subsequent nursing facility care, per day, for the evaluation and management 
of a 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 patient has developed a significant complication or a significant 
new problem. Typically, 25 minutes are spent at the bedside and on the 
patient's facility floor or unit.

Subsequent nursing facility care, per day, for the evaluation and management 
of a patient, which requires at least 2 of these 3 key components: A comprehensive 
interval 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. 
The patient may be unstable or may have developed a significant new problem 
requiring immediate physician attention. Typically, 35 minutes are spent 
at the bedside and on the patient's facility floor or unit.

Evaluation and management of a patient involving an annual nursing facility 
assessment, which requires these 3 key components: A detailed interval 
history; A comprehensive examination; and Medical decision making that 
is of low to 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 patient is stable, recovering, or improving. 
Typically, 30 minutes are spent at the bedside and on the patient's facility 
floor or unit.

Domiciliary or rest 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 with the patient and/or family or caregiver.

Domiciliary or rest 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 with the patient and/or family 
or caregiver.

Domiciliary or rest 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 with the patient and/or family or caregiver.

Domiciliary or rest 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 with the patient and/or family or caregiver.

Psychotherapy, 45 minutes with patient and/or family member

Domiciliary or rest 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 with the 
patient and/or family or caregiver.

Domiciliary or rest 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 with the patient and/or family 
or caregiver.

Domiciliary or rest 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 
with the patient and/or family or caregiver.

Domiciliary or rest 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 of moderate 
to high severity. Typically, 40 minutes are spent with the patient and/or 
family or caregiver.

Domiciliary or rest home visit for the evaluation and management of an 
Typically, 60 minutes are spent with the patient and/or family or caregiver.
established patient, 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. 

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.

Psychotherapy, 60 minutes with patient and/or family member

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

Psychotherapy for crisis; first 60 minutes

Psychoanalysis

Hypnotherapy

Ophthalmological services: medical examination and evaluation with initiation 
of diagnostic and treatment program; intermediate, new patient

Cervical or vaginal cancer screening; pelvic and clinical breast examination

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

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