Review of professional claims with emergency department level 5 E&M codes
This policy governs Anthem's post-payment review of professional emergency department claims billed with level 5 E&M codes (99285 or G0384) to ensure documentation supports billed level of service; it affects providers submitting ED professional claims to Anthem.
No material clinical or coverage changes in this revision.
Documentation-Supported Reimbursement
Documentation-supported reimbursement
Reimbursement will be based on the level of ED E&M code supported by the submitted documentation after Anthem's review against AMA CPT and Anthem guidelines.
ED Level 5 E&M Codes and Review Trigger
| 99285 | Emergency department level 5 E&M (CPT) |
| G0384 | Hospital outpatient clinic visit, emergency department visit (HCPCS) |
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