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E&M Services Billed with Treatment Room Revenue Code

April 29, 2022

Dear Provider,

Thank you for your continued partnership with Wellcare. 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 we will be implementing effective May 1, 2022.

Policy Number: CC.PP.071
Policy Name:
Evaluation and Management Services Billed with Treatment Rooms
Line of Business: Medicare
Policy Description: Based on correct coding principles, this policy disallows E&M services in treatment rooms as this does not represent a specific treatment type of service. It also disallows for hospital facility charges representing treatment room services when the service provided is not a treatment.

Policy Link: Medicare Payment Policy

For detailed information about these policies, please refer to our website. For questions about this or any of our payment policies, please don't hesitate to reach out to our Provider Services team at 1-855-538-0454.

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Last Updated On: 5/26/2022