Emergency CPT code billing with E & M code

E&M service with Emergency

Emergency Department Services : Claims for emergency department E&M services must be accompanied by an appropriate diagnosis code reflecting the need for the level of E&M services rendered. Inappropriate upcoding is subject to audit.

No distinction is made between new and established patients in the emergency department. Providers must use CPT-4 codes 99281 – 99285 when billing for emergency department services, whether the patient is new or established. If a recipient visits the emergency department more than once on the same date of service, the provider should use the recipient’s records from the first visit instead of completing a new evaluation. Claims for E&M services rendered more than once in the emergency department by the same provider, for the same recipient and date of service are reimbursable only if they contain medical justification or an indication from the provider that the recipient came to the emergency department more than once in the same day.

Note: Evaluation and Management (E&M) CPT-4 codes 99281 – 99285 are physician service codes and under most circumstances, only physicians may submit claims for these codes. The treating physician and the emergency department services may not submit separate claims using these codes for the same recipient and date of service.

E&M codes 99284 and 99285 are not reimbursable together or more than once to the same provider, for the same recipient and date of service. Instead, providers should use code 99283 to bill for second and subsequent recipient visits on the same date of service.


E&M: Place of Service/Facility Type Codes : The CPT-4 and HCPCS codes listed below are restricted to the following facility type/Place of Service codes:

CPT-4 Code Description- Facility TypeUB-04 -Place of Service Code CMS-1500

99201 – 99215 Office Services 13, 71, 72, 73, 74, 75, 76, 79, 83 11, 22, 24, 25, 53, 65, 71, 72

99221 – 99233, 99238, 99239 Hospital Services 11, 12 21, 25

99241 – 99245 Office Consultation 13, 14, 24, 33, 34, 44, 54, 64, 71, 72, 73, 74, 75, 76, 79, 83, 89 11, 12, 22, 23, 24, 25, 53, 55, 62, 65, 71, 81, 99

99251 – 99255 Initial Inpatient Consultation 11, 12, 25, 26, 27, 65, 71, 73, 74, 75, 76, 86 21, 31, 32, 53, 54, 99


The CPT-4 and HCPCS codes listed below are restricted to the following facility type/Place of Service codes (continued):

CPT-4 Code Description                Facility Type UB-04                     Place of Service Code CMS-1500

99281 – 99285                                 Emergency Department Services            14* 23

99291 – 99292                                 Critical Care Services                           11, 12, 13, 14* 21, 22, 23

99341 – 99350                                 Home Services                         14, 24, 33, 34, 44, 54, 64 12, 55, 99

99460, 99462                                    Newborn Care                              11, 12 21

99477                                                Neonate Intensive E&M              13, 14, 24, 34, 44, 54 or 64 21



HCPCS Code Description Facility Type UB-04 Place of Service Code CMS-1500

X9922 – X9970 Adult Subacute Care 27** 99**

X9922 – X9970 Pediatric Subacute Care 27** 99**

* Facility type “14” must be billed in conjunction with admit type “1.”

** Facility type “27” or Place of Service code “99” must be billed in conjunction with modifier HB to denote adult or HA to denote child.



Refer to the CMS-1500 Completion or UB-04 Claim Form

Completion – Outpatient section of the appropriate Part 2 manual for facility type/Place of Service codes and descriptions. Refer to the end of these sections to see the correspondence between local and national codes.

Claims for services rendered in an inappropriate facility type/Place of Service will be denied with RAD code 062, “The facility type/Place of Service is not acceptable for this procedure.”

Note: The codes listed on the previous page cannot be billed with facility type code “89” on the UB-04 or Place of Service code “81” on the CMS-1500 (independent laboratories). Claims for these codes billed with facility type code “89” or Place of Service code “81” will be denied.

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