Reimbursement Level of Certain Evaluation and Management (E/M) Services
Defines Humana's reimbursement determination for higher-level office/outpatient evaluation and management (E/M) services for Medicare Advantage products, affecting providers who bill CPT 99204, 99205, 99214, and 99215.
No material clinical or coverage changes in this revision.
Reimbursement determination for higher-level E/M services
Reimbursement determination for higher-level E/M services
Covered when ALL of the following are met:
Reimbursement level is determined by review of diagnosis coding and clinical information.
Adjustment may result in a downward reimbursement to the supported level.
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.