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When using time to select an office/outpatient E/M code, which activities may be counted toward total time?

Time spent by clinical staff on the patient

Only time spent on the date of service, including documentation, ordering, reviewing results, and counseling

Time spent on previous or subsequent encounters

Only face-to-face time with the patient

to track

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2026 Statistics

Key Facts: CEMC Exam

150

Total Items

AAPC

5h 40m

Exam Time

AAPC

$299

AAPC Member Fee

AAPC

2021/2023

Major E/M Revisions

AMA

The AAPC CEMC consists of 150 MCQ items over 5h40m with 70% passing. Fee $299 AAPC member. Master 2021 office E/M revision (MDM grid: problems + data + risk; 2 of 3 must meet) and 2023 expansion to inpatient/observation/consult/ED. Time-based selection rules and split/shared visit logic.

Sample CEMC Practice Questions

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1Effective January 1, 2021, which CPT code was deleted from the office/outpatient E/M section?

A.99201

B.99202

C.99211

D.99215

Explanation: CPT code 99201 (new patient, straightforward MDM) was deleted effective January 1, 2021, as part of the office/outpatient E/M revision. New patient codes now begin at 99202. Codes 99202-99205 and 99211-99215 remain.

2Under the 2021 office/outpatient E/M guidelines, what TWO factors may be used to select the level of service?

A.History and exam

B.MDM or total time on date of service

C.Number of diagnoses and treatment options

D.Risk and complexity of data only

Explanation: Effective 1/1/2021, providers may select the office/outpatient E/M level using either Medical Decision Making (MDM) OR total time spent on the date of the encounter. History and exam are still performed and documented when medically appropriate but no longer drive code selection.

3When using MDM to select the level of an office/outpatient E/M service, how many of the three MDM elements must meet or exceed the level chosen?

A.1 of 3

B.2 of 3

C.3 of 3

D.All elements at the highest level

Explanation: Two of the three MDM elements (problems addressed, data reviewed/analyzed, risk of complications) must meet or exceed the level selected. This mirrors the prior MDM table but applies to the new 2021 grid.

4In the 2021 MDM grid, a single stable chronic illness represents which level of problems addressed?

A.Minimal

B.Low

C.Moderate

D.High

Explanation: One stable chronic illness, or two or more self-limited problems, qualifies as a LOW number and complexity of problems addressed. Two or more stable chronic illnesses also qualify as moderate.

5A physician orders a CBC, BMP, and chest X-ray during an office visit. How many points does this contribute under MDM Category 1 data?

A.1 point

B.2 points

C.3 points

D.4 points

Explanation: Each unique test ordered or reviewed counts as 1 point under Category 1. CBC (1), BMP (1), and chest X-ray (1) total 3 points. Three points meets the moderate-level data requirement when only Category 1 is used.

6Which of the following risk factors qualifies as MODERATE risk under the 2021 MDM guidelines?

A.Over-the-counter medication recommendation

B.Prescription drug management

C.Decision regarding hospitalization

D.Drug therapy requiring intensive monitoring for toxicity

Explanation: Prescription drug management, whether starting, stopping, or continuing a medication with active management, is explicitly listed as MODERATE risk. Documentation should reflect that the provider made the management decision.

7Effective January 1, 2023, the MDM-or-time selection method was extended to which additional E/M categories?

A.Office/outpatient only

B.Inpatient/observation, consultations, ED, nursing facility, home/residence

C.Critical care services 99291-99292

D.Preventive medicine services 99381-99397

Explanation: The 2023 CPT update extended MDM-or-time selection to inpatient/observation (99221-99239), consultations (99242-99245), emergency department (99281-99285, time not used for ED), nursing facility (99304-99316), and home/residence (99341-99350) services.

8Under the 2023 E/M guidelines, ED codes 99281-99285 may be selected using which method(s)?

A.MDM only

B.Time only

C.MDM or time

D.History and exam

Explanation: Emergency department E/M codes (99281-99285) are selected by MDM only. Time is not used because ED providers manage multiple patients simultaneously and continuous time tracking per patient is impractical.

9When using time to select an office/outpatient E/M code, which activities may be counted toward total time?

A.Only face-to-face time with the patient

B.Only time spent on the date of service, including documentation, ordering, reviewing results, and counseling

C.Time spent by clinical staff on the patient

D.Time spent on previous or subsequent encounters

Explanation: Total time includes all qualifying activities performed by the reporting practitioner on the date of the encounter: preparing to see the patient, obtaining history, performing exam, counseling, ordering tests, documenting in the chart, communicating results, and care coordination not separately reported.

10An undiagnosed new problem with uncertain prognosis represents which level of problems addressed?

A.Low

B.Moderate

C.High

D.Minimal

Explanation: An undiagnosed new problem with uncertain prognosis is explicitly classified as MODERATE under the 2021 MDM grid. Examples include new lump that may be malignant or new arrhythmia of unclear etiology.

About the CEMC Exam

AAPC specialty credential for E/M coders. Validates deep expertise in 2021 office/outpatient revision (99202-99215, MDM- or time-based) and 2023 expansion (inpatient/observation/consult/ED/nursing facility/home), MDM elements (problems, data, risk), time-based selection, preventive services, telehealth, critical care, and split/shared visits.

Questions

150 scored questions

Time Limit

5 hours 40 minutes

Passing Score

70%

Exam Fee

$299 AAPC member (AAPC)

CEMC Exam Content Outline

30%

2021/2023 E/M Guidelines (MDM-based)

MDM grid (problems addressed, data, risk), time-based selection, 99417/G2212 prolonged

20%

Office/Outpatient E/M (99202-99215)

New vs established (3-year rule), MDM levels, time ranges per code

15%

Inpatient/Observation E/M (99221-99239)

2023 merger of observation into inpatient codes; admit/subsequent/discharge

15%

Other E/M (Consults, Critical Care, Nursing Facility, Home, Preventive)

99242-99245 consults (Medicare doesn't pay), critical care, preventive 99381-99397

10%

ICD-10-CM E/M Documentation Support

Symptoms vs definitive Dx, diabetes 'with' guidelines, sequencing

10%

Modifiers and Compliance

25, 24, 57, 95 telehealth, AI admitting, OIG modifier 25 audit focus

How to Pass the CEMC Exam

What You Need to Know

Passing score: 70%
Exam length: 150 questions
Time limit: 5 hours 40 minutes
Exam fee: $299 AAPC member

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CEMC Study Tips from Top Performers

1Master MDM grid: 2 of 3 elements (problems/data/risk) must meet level; problems addressed counts complexity at encounter; data has 3 categories; risk includes drug therapy management decisions

2Know time-based selection: TOTAL time on date of service (pre/intra/post); choose code whose time band fits; add 99417 (or G2212 Medicare) for prolonged time beyond highest code

3Memorize 2023 E/M expansion: MDM/time selection extended to inpatient/observation 99221-99239, consult 99242-99245, ED 99281-99285, nursing facility 99304-99316, home 99341-99350

4Understand split/shared visits 2024: substantive portion (>50% of TOTAL time OR substantive MDM portion) determines who bills (physician vs APP); modifier FS for split/shared

Frequently Asked Questions

What is the 2021 E/M MDM grid?

MDM has three elements: (1) Number/complexity of problems addressed, (2) Amount/complexity of data reviewed (Categories 1-3), (3) Risk of complications/morbidity/mortality. Level requires 2 OF 3 elements meeting the level on the grid. The grid expanded in 2023 to cover inpatient, observation, consult, ED, nursing facility, and home E/M services.

How does time-based E/M selection work?

For office E/M (since 2021) and most other settings (since 2023, except ED), time-based selection counts TOTAL TIME ON DATE OF SERVICE — pre-service review, intra-service face-to-face, post-service documentation/orders/communication/coordination/counseling. Each code has a time range; choose the code whose time band fits the documented total. Add-on prolonged 99417 (or G2212 for Medicare) for time exceeding the highest code's range.

Why doesn't Medicare pay consultation codes?

CMS stopped paying consultation codes (99241-99245 and 99251-99255) effective 1/1/2010, citing low documentation compliance with the 'Request, Reason, Report' requirement. For Medicare patients requiring consultation services, bill with the appropriate office E/M (99202-99215) or inpatient E/M (99221-99223) code instead, even if the encounter meets consultation criteria.