Updates to correct coding editing

Effective for Medicaid claims processed on or after February 1, 2025, we are updating our professional editing system to align with the American Medical Association (AMA) CPT^® Manual and HCPCS Level II Manual correct coding guidelines for the following services:

• Appropriate billing of interprofessional telephone/internet consultation evaluation and management (E/M) services: 
• According to the AMA CPT Manual: 
• CPT codes 99441‑99443 (telephone E/M services) should not be reported on the same day, the previous seven days, or the following day as CPT codes 99202‑99439 (office visits), 99446‑99499 (interprofessional, telephone, internet, or electronic health record consultations), or 99091 (collection of interpretation of physiological data) when billed with the same primary diagnosis by the same provider.
• CPT codes 99441‑99443 (telephone E/M services) should not be reported when CPT codes 99421‑99423 (online digital E/M services) were billed in the previous seven days with the same primary diagnosis by the same provider.
• According to the HCPCS Level II Manual:
• HCPCS codes G2010 (remote evaluation of recorded video and/or image), and G2012, G2252 (brief check‑in by MD/QHP) should not be reported on the same day, the previous seven days, or the following day as CPT codes 99202‑99439, 99446‑99499, or 99091 when billed with the same primary diagnosis by the same provider.
• CPT codes 99441‑99443 (telephone E/M services) should not be reported when CPT codes 99421‑99423 (online digital E/M services) were billed in the previous seven days with the same primary diagnosis by the same provider.

Claim lines not billed in accordance with the correct coding guidance outlined above will be denied. If you disagree with a claim reimbursement decision, please follow the claim dispute process (including submission of such documentation with the dispute) as outlined in the provider manual.

If you have questions about this communication or need assistance with any other items, contact Provider Services at 800‑450-8753.