MDM level combinations: problems, data and risk.
Pick the level of each element and see the medical decision making level - and the office visit code - it adds up to. Every one of the 64 combinations is below.
The rule, per the AMA CPT E/M guidelines: to qualify for a level of medical decision making, two of the three elements must meet or exceed that level. In practice: rank the three elements and take the middle one.
Common questions
Problems are high but risk is low. What is the MDM level?
It depends on data, the third element. With minimal or limited data the level is Low (99203 new, 99213 established). With moderate data it is Moderate (99204 / 99214), and with extensive data it is High (99205 / 99215). High problems alone never set the level - a second element has to reach the same row.
Risk is moderate (prescription drug management) and problems are low. What level?
Data decides again: minimal or limited data gives Low (99213 established); moderate or extensive data gives Moderate (99214).
All three elements are at different levels. Which one wins?
None of the extremes. Put the three in order and take the middle one: that is the highest level two of the three meet or exceed. Straightforward, Moderate and High add up to Moderate.
Can one element raise the level by itself?
No. A single element at High, with the other two lower, does not make the visit High. Two of the three must meet or exceed a level for the visit to reach it.
Does documented time change this?
Office visits can also be selected by total time on the date of the encounter. When the documented time supports a higher code than medical decision making, time may be used instead. The combinations on this page are the medical decision making route.
What each element level means
The element levels are defined in the AMA CPT E/M guidelines. In short: problems runs from one self-limited problem (minimal) to a threat to life or bodily function (high); data from minimal or none to extensive (tests, documents and historians, independent interpretation, discussion with another clinician); risk from minimal to high, for the management chosen at the visit. The E/M coding guidelines guide walks through each one.
Have the note in front of you?
The free E/M calculator reads it, sets each element from the documentation and shows the level.
Explained in our own words for education; it does not reproduce the AMA's table. For the authoritative definitions see the AMA CPT E/M guidelines. CPT® is a registered trademark of the American Medical Association. Updated 2026-10-20.