Posted in Insurance, Training, Updates

EmblemHealth (NY) E&M codes reimbursement policy: updated for 2021

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.



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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