ED Leveling Turn On Provider Notification
August 28, 2024
Dear Provider,
Thank you for your continued partnership with Fidelis Care. As you know, we continually review and update our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members. We are writing today to inform you of new policies Fidelis Care will be implementing effective 9/30/2024.
| Policy Number | Policy Name | Policy Description | Lines of Business |
|---|---|---|---|
| CC.PP.064 | Emergency Department (ED) Evaluation and Management (E&M) Coding for Facility Claims | This policy describes how the Plan reimburses facility claims billed with Evaluation and Management (E/M) codes at Level 4 (99284/G0383) and Level 5 (99285/G0384) for services rendered in an emergency department. This policy is based on coding principles established by the Centers for Medicare and Medicaid Services (CMS) and the CPT and HCPCS code descriptions. | Medicaid |
For detailed information about these policies, please refer to our website. And for questions about this or any of our payment policies, please don’t hesitate to reach out to our Provider Services team at 1-888-453-2534.
Sincerely,
Fidelis Care