Provider notice for COVID-19 testing
Evaluation and management services for COVID-19 testing - professional
Effective with dates of service on or after September 1, 2022, Empire will facilitate review of selected claims for COVID-19 visits reported with Evaluation and Management (E/M) services submitted by professional providers to align with CMS reporting guidelines. When the purpose of the visit is for COVID-19 testing only, reimbursement for CPT® code 99211 (office or other outpatient visit) is allowed when billed with place of service office (11), mobile unit (15), walk-in retail health clinic (17), or urgent care facility (20). Claims for exposure only may be affected. Professional providers are encouraged to code their claims to the highest level of specificity in accordance with ICD-10 coding guidelines.
Prior to payment, Empire will review the selected claims to determine, in accordance with correct coding requirements and/or reimbursement policy as applicable, whether the E/M code level submitted is appropriate for the COVID-19 visit reported. If the visit is determined to be solely for the purpose of COVID-19 testing, Empire will reimburse using CPT code 99211.
Professional providers who believe their medical record documentation supports reimbursement for the originally submitted level for the E/M service will be able to follow the Claims Payment Dispute process (including submission of such documentation with the dispute) as outlined in the provider manual.
If you have questions on this program, contact Provider Services at 1-800-450-8753 for Medicaid Managed Care or the number on the back of your patient’s member ID card for Commercial.
June 2022 Newsletter