Effective August 15, 2022: New Payment Policy - E/M Services Billed with Treatment Room Revenue Codes

Date: 05/20/22

Superior HealthPlan presents a new payment policy that addresses reimbursement limitations for facility Evaluation and Management (E/M) charges billed in conjunction with a treatment room revenue code. As a result, the new policy has been added, and is posted on Superior’s Clinical, Payment and Pharmacy Polices webpage for review, prior to its implementation:

POLICY	EFFECTIVE DATE	APPLICABLE PRODUCTS	NEW POLICY OVERVIEW
Evaluation and Management (E/M) Services Billed with Treatment Room Revenue Codes
Policy Number: CC.PP.071 Policy Number: CC.PP.072 (Medicare Only)	08/15/2022	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Health Insurance Marketplace (Ambetter from Superior HealthPlan) and Medicare (Wellcare By Allwell)	The purpose of this policy is to define reimbursement guidelines for claims billed with revenue codes 760, 761 and 769 that are billed in conjunction with an evaluation and management service according to the application criteria defined in the payment policy.    Superior will not reimburse for facility Evaluation and Management (E/M) charges billed in conjunction with a treatment room revenue code as these services do not represent a specific procedure performed in a treatment room.

To review all payment policies, please visit Superior’s Clinical, Payment and Pharmacy Polices webpage.

For questions or additional information, please contact Superior Provider Services at:

• 1-877-391-5921 Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Medicare (Wellcare By Allwell)
• 1-877-687-1196 Health Insurance Marketplace (Ambetter from Superior HealthPlan)