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UnitedHealthcare further delays rollout of ED professional coding policy

October 08, 2020
Area(s) of Interest: Payor Issues and Reimbursement 


UnitedHealthcare (UHC) announced in its October 2020 Network Bulletin that it will further delay the implementation date of its new Commercial and Medicare Advantage Emergency Department (ED) Professional Evaluation & Management (E/M) Coding Policies until the second quarter of 2021. The Medicare Advantage policy, originally to be effective on May 1, 2020, was initially delayed until August 1, 2020, due to the coronavirus pandemic. While the commercial policy was originally set to take effect on April 1, 2020, it, too, will not be implemented until 2021.

When the policy takes effect, UHC will begin using the Optum Evaluation and Management Professional (E/M Pro) tool for emergency department claims submitted with a level 5 (99285) E/M code. Based on the diagnosis indicated, the E/M Pro tool will determine 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 more information, contact UHC Provider Services at (877) 842-3210.

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