Welcome to the Evaluation and Management Services Information Center! Here you will find helpful resources to assist you with Evaluation and Management Services, appropriate medical record documentation and coding.
- CMS Evaluation and Management Manuals, Guidelines, Education and General Information
- CMS Fact Sheets
- Coding References Links
- Cahaba GBA Web Site
- Reasonable and Medically Necessary Services and Documentation Requirements
- Effective January 1, 2010, local A/B MACs will no longer recognize AMA Current Procedural Terminology (CPT) consultation codes (ranges 99241-99245 and 99251-99255) for inpatient facility and office/outpatient settings. Refer to MLN Matters® article MM6740 at MLN Matters® Article MM6740. (Revised February 24, 2010)
- CMS Home Page – CMS Programs and Information
- Medicare Claims Processing Manual, Pub. 100-04, Chapter 12, Section 30.6: E&M Services Codes
- The 1995 and 1997 Evaluation and Management Services Documentation Guidelines
- Contractors and A/B Medicare Administration Contractors (MACs) are to continue medical record reviews using both the 1995 and 1997 Documentation Guidelines for E&M Services (whichever is more advantageous to the physician).
- Evaluation and Management Services Guide
- FAQs: Evaluation and Management Services Documentation
- Guidelines for Teaching Physicians, Interns and Residents
- Medicare Information for Advanced Practice Nurses and Physicians Assistants
- CMS Transmittals – Program transmittals are used to communicate new or changed policies, and/or procedures that are being incorporated into a specific CMS program manual. Search for E&M Services transmittals.
- CMS Medical Review Process – The Medical Review Program is designed to promote a structured approach in the interpretation and implementation of Medicare policy.
- Comprehensive Error Rate Testing (CERT) – View Comprehensive Error Rate Testing (CERT) Reports, Newlines, Sample Letters, etc.
- Medicare Coverage Center – Locate Local Coverage Determinations and National Coverage Determinations Policies
CMS Fact Sheets:
Coding References Links:
- CMS Correct Coding Initiative (CCI)
- American Medical Association (AMA) – AMA Coding Information and Ordering Products
Cahaba GBA Web Site:
- Cahaba GBA Home Page – Welcome to Cahaba GBA, search for provider information and resources
- Cahaba University Home Page – Welcome to Cahaba University, an e-learning environment, where you can register for self-paced courses.
- Cahaba GBA Listserv – Sign up for Cahaba GBA E-mail Notification Service
- Modifiers for Billing Medicare
Reasonable and Medically Necessary Services and Documentation Requirements:
- Cahaba GBA Medical Review Home Page – The goal of the contractor’s MR Program is to participate in reducing the contractor’s claims payment error rate (CERT) by identifying, through analysis of data and evaluation of other information, program vulnerabilities concerning coverage and coding made by individual providers and by taking the necessary action to prevent and address the identified vulnerabilities.
- CMS Article Database – This section represents articles published by the Medical Review Department in an effort to educate the provider community on proper coding and billing related to Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), and/or from issues noted in the Carrier’s claims and probe review activities.
Cahaba GBA Medical Review Articles:
- “Incident To” Article – E&M and “Incident To” Services
- E&M Services – Appropriate Documentation Article – E&M and Medical Record Documentation
- Cahaba GBA Local Coverage Determinations (LCD)- Access our Local Coverage Determinations (LCDs)
- National Coverage Determinations (NCDs)
Evaluation and Management Documentation Tools:
View E&M tools for appropriate medical record documentation of medical necessity, E&M guidelines for documentation of E&M levels of service and other helpful tools.
- PDF PowerPoint Presentations: The education materials in PDF format were current at the time of creation. For the most recent signature guidelines, refer to the new Change Request (CR) 6698- Signature Guidelines for Medical Review Purposes .
- The 1995 and 1997 Evaluation and Management Services Documentation Guidelines Carriers and A/B Medicare Administration Contractors (MACs) are to continue medical record reviews using both the 1995 and 1997 Documentation Guidelines for E&M Services (whichever is more advantageous to the physician).
- General Documentation Points for Accurate Medical Records
- Clinical Examples of CPT codes for Evaluation and Management Services: Refer to Appendix C of the American Medical Association Current Procedural Terminology (CPT ®) 2011 Professional or Standard Edition.
- PDF PowerPoint Presentations:The education materials in PDF format were current at the time of creation. For the most recent signature guidelines, refer to the new Change Request (CR) 6698- Signature Guidelines for Medical Review Purposes.
Cahaba GBA Contact Us - Provider Contact Centers
Page last updated:
September 20, 2012