As a reminder, and as previously communicated in Provider News, providers should report evaluation and management (E/M) services 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 that 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).


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


Past notifications related to the E/M services correct coding — professional program may be found on our provider website.



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March 2022 Anthem Provider News - Wisconsin