Postponed: review of professional claims with emergency room level 5 E/M codes

We communicated to you on May 1, 2019, that we were initiating post-payment reviews for professional ER claims billed with level 5 ER E/M codes 99285 and G0384. Our implementation of this policy has been postponed.

Note that this update relates only to the policy announced May 1, 2019. All other current policies applicable to you, including, but not limited to, other audit or reimbursement policies pertaining to ER claims are unaffected by this update. We will keep you informed about the initiation of the review process; however, as always, we require proper coding and billing to ensure prompt and accurate payment.