Posted in Insurance, Payers and CPT reinbursement

EmblemHealth Preventive Care/Screening Services Coverage-(update)

In 2019-

Under the Affordable Care Act, Emblem covers the following codes: G0442,G0443, G0444, G0445, G0446, G0446. When billing both E/M codes and the above mentioned G-codes, both modifier 25 and 59 have to be appended to the codes, respectively.

EmblemHealth will pay the claims with the above mentioned codes that have the appropriate above mentioned Modifiers retroactively to 07/15/2016.

Any claims billed on 11/12/2018 will be reviewed prospectively.

There is no need to resubmit the claims. All affected claims will be re-processed.

Author:

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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