Evaluation and management services correct coding reminder - professional

As a reminder, we previously communicated in the January 2021 and June 2021 editions of Provider News that Evaluation and Management (E/M) services should be reported in accordance with the American Medical Association (AMA) CPT® manual and CMS guidelines for billing E/M service codes: Documentation Guidelines for Evaluation and Management. The coded service should reflect and not exceed the level needed to manage the member’s condition(s).

 

The maximum level of service for E/M codes will be based on the complexity of the medical decision-making or time and reimbursed at the supported E/M code level and fee schedule rate.

 

Providers who believe their medical record documentation supports reimbursement for the originally submitted level for the E/M service will be able to follow the dispute resolution process (including submission of such documentation with the dispute) as outlined in the Provider Manual.

 

If you have questions on this program, contact your Provider Experience representative.

 

706-0322-PN-CT