CommercialBilling CodesHigh impact
22-266 Bill E&M Services Correctly with New Payment Policy to Avoid Payment Delays
Health Net·CA·Reimbursement
Effective date
Jun 8, 2022
We identified it
Jun 20, 2026
Summary
Health Net and Wellcare By Health Net will deny facility E&M charges when billed with treatment room revenue codes 760, 761, and 769. Treatment room revenue codes should only be used for actual procedures performed in treatment rooms, not for office-based E&M services.
Action Required
Immediately: Billing team must stop billing facility E&M services with revenue codes 760, 761, and 769. Review current billing practices to ensure treatment room revenue codes are only used for actual procedures performed in treatment rooms on the same day, not for office-based E&M services. Update billing system edits to prevent incorrect code combinations. Claims billed incorrectly will be denied.