With the changes to the E&M codes, for the year 2021, EmblemHealth updated their reimbursement policy for providers.
The following is now the guidelines/reminder for E&M Reimbursement: documentation requirements
• The CPT® coding guideline updates only apply to 99202-99215.
– Other codes within the evaluation and management section of the CPT book are still subject to previous reimbursement policies.
• Chief complaint (Reason for visit) must be clearly documented.
• A clinically appropriate history and exam are still required.
• Medical Necessity, Medical Decision Making and Assessment & Plan are required to be
• When time is the determining factor for code selection, all start and stop times must be documented to substantiate total time on the date of the encounter.