Audit of Medicare Payments for Emergency Department Services Provided in Nonemergency Department Sites of Service

An emergency department is defined as an organized hospital-based facility for the provision of unscheduled or episodic services to patients who present for immediate medical attention. Certain Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes should be used only if a Medicare enrollee is seen in the emergency department and the services described by the codes' definitions are provided. Medicare reimburses providers based on the patient's documented service needs at the time of the visit and based on the site of service. This audit will determine whether Medicare appropriately paid hospitals and physicians for emergency department services provided in nonemergency department sites of service.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
December 2023	Centers for Medicare and Medicaid Services	Audit of Medicare Payments for Emergency Department Services Provided in Nonemergency Department Sites of Service	Office of Audit Services	WA-23-0041 (W-00-23-35904)	2025