According to Aetna, effective for DOS 3/1/24 and thereafter, evaluation codes 99212-99215, 99415–99417 will no longer be reimbursed separately when billed on the same DOS for the same member by the same provider.
This change will apply to Commercial and Medicare Advantage Plans.
Modifier 25 will not be able to override this claim edit and the payment for the E/M codes will be included in either code G2082 or G2083
G2082-temporary code for 2024- office or outpatient visit for evaluation and management of already established patient that requires physician or other qualified health care professional supervision up to 56 mg of esketamine nasal self- administration, includes 2 hours post-administration observation.
G2083-temporary code for 2024- office or outpatient visit for evaluation and management of already established patient that requires physician or other qualified health care professional supervision greater than 56 mg of esketamine nasal self- administration, includes 2 hours post-administration observation.
CTP codes 99415, 99416 are used to report the total amount of face-to-face time spent with the patient and/or family/caregiver by clinical staff in the office or
other outpatient setting, on a given date of service even if the time is not continuous. The
physician or qualified health care professional is present to provide direct supervision of the
clinical staff. Codes 99415, 99416 should not be used for prolonged services of less than 30
minutes total duration on a given date.
Want to stay current with the up-to date medical billing and coding information? Follow my blog. #medialbilling #medicalcoding #reimbursement
Recent Blog Posts
UHC Community Health of MA: 2 DSNP 2 plans important coverage update.
Are you a provider from MA that accepts UHC plan types mentioned below and is having issues with reimbursement? It could be due to a recent MA Medicaid (MassHealth) change to the eligibility for DSNP plan members. Plans affected: UHC Community Health plan ls of Massachusets-DSNP plans: Due to a termination of MA Medicaid (MassHealth)…
NYS RX: adult vaccine reimbursement and Billing change
There is an update to how the NYS Medicaid Pharmacy program will reimburse the pharmacies for vaccines that are billed by the NDC#. This change does not apply to the vaccines administered under Vaccines for children program. Proper Billing: for any vaccines that are billed by the NDC One claim should be submitted with a…
Healthfirst: psychiatric evaluation reimbursement update
For any DOS effective 10/1/25 and thereafter Healthfirst will reimburse psychiatric evaluation services that is with the accordance to the CMS LCD #L35101 and the Local Coverage Article (LCA) A57130 for Jurisdictions H & L. To access the Local LCD please click here. To access the Local LCA- for codes info, please click here. The…
KR2 Medical Billing 
Leave a comment