Review of professional claims with emergency department level 5 E&M codes
This policy governs Anthem's postpay review process for professional emergency department claims billed with level 5 E&M codes (CPT 99285 or G0384), describing documentation requests and evaluation criteria for reimbursement; it affects providers billing Anthem for ED professional services.
No material clinical or coverage changes in this revision.
Documentation Determination for Reimbursement
Documentation-based reimbursement determination
Reimbursement will be based on the emergency department E&M code that the submitted documentation supports after Anthem's review.
Codes Under Review and Review Trigger
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.