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We will follow 2023 AMA evaluation and management guidelines
November 1, 2022

This article is for all providers except dentists caring for our members

Effective January 1, 2023, there will be significant updates to the American Medical Association’s (AMA) Evaluation and Management Code and Guidelines for hospital inpatient, observation, and outpatient services. We’d like to inform you of what some of those changes are, and that we will continue to follow them.

Please be mindful of these updated guidelines as you bill for services in 2023, some of which include:

  • Emergency department services
  • Evaluation and management (E/M) services
    • This includes all additions, deletions, revisions, and time thresholds associated with each code
    • We will use AMA selection criteria for determining E/M levels of service
  • Hospital discharge day management
  • Initial and subsequent care services- initial hospital inpatient or observation care code guidelines
    • CPT codes 99221-99223 will be reimbursed based on the same provider with same specialty and same federal tax ID number
  • Inpatient or observation consultation codes (99252-99254)
    • One consultation code per admission for providers with the same specialty and federal tax ID number
  • Nursing facility care code guidelines