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UnitedHealthcare delays rollout of ED professional coding policy

April 17, 2020
Area(s) of Interest: Payor Issues and Reimbursement Practice Management 


Due to the COVID-19 public health emergency, the implementation date for UnitedHealthcare’s new Medicare Advantage Emergency Department Professional Evaluation & Management (E/M) Coding Policy has been delayed until August 1, 2020. The policy was originally set to take effect on May 1, 2020.

The  policy focuses on professional emergency department claims submitted with a level 5 (99285) E/M code.

Citing an effort to reduce the administrative burden of requesting and obtaining medical records for review of these level 5 codes, United will begin using the Optum Evaluation and Management Professional (E/M Pro) tool, which determines appropriate E/M coding levels based on a review of the diagnosis codes submitted on the claim.  Based on the diagnosis indicated, the E/M Pro tool determines the level of complexity for the E/M service submitted and may adjust the Level 5 E/M code (99285) to an alternative E/M code. 

For additional information regarding this policy, please contact UHC Provider Services at (877) 842-3210.

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