Audit of Medicare Emergency Department Evaluation and Management Services
An emergency department is defined as an organized, hospital-based facility for providing unscheduled or episodic services to patients who present for immediate medical attention. Certain Current Procedural Terminology (CPT) codes should only be used when a beneficiary is seen in an emergency department and the services described by the health care CPT coding system code definition are provided. Medicare reimburses physicians based on a patient's documented needs at the time of a visit. All evaluation and management (E/M) services reported to Medicare must be adequately documented so that medical necessity is clearly evident. This review will determine whether Medicare payments to providers for emergency department E/M services were appropriate, medically necessary, and paid in accordance with Medicare requirements.
|Announced or Revised||Agency||Title||Component||Report Number(s)||Expected Issue Date (FY)|
|Revised||Centers for Medicare and Medicaid Services||Audit of Medicare Emergency Department Evaluation and Management Services||Office of Audit Services||W-00-21-35877; W-00-22-35877||2023|