Reimbursement Level of Certain Evaluation and Management (E/M) Services
Defines Humana's process for determining reimbursement level for higher-level office or outpatient E/M CPT codes for Medicare Advantage products and applies to professional services and providers submitting claims.
No material clinical or coverage changes in this revision.
Reimbursement Criteria
Reimbursement criteria
Covered when ALL of the following are met:
Applicable product
- Medicare Advantage products (policy applies to professional services).
Higher-level Office/Outpatient E/M Codes
| 99204 | Office or other outpatient visit, new patient, higher-level E/M |
| 99205 | Office or other outpatient visit, new patient, highest-level E/M |
| 99214 | Office or other outpatient visit, established patient, higher-level E/M |
| 99215 | Office or other outpatient visit, established patient, highest-level E/M |
Reimbursement Determination & Adjustment
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.