Medicare AdvantageBilling CodesHigh impact
New Payment Policy: Leveling of Care: ED E/M Overcoding for Professional Services (CC.PP.076) & Office-based E/M Overcoding (CC.PP.066)
Ambetter·IN · Emergency Medicine, General Practice, Family Medicine +1 more·Claims & Billing
Effective date
Sep 29, 2026
We identified it
Aug 26, 2026
Summary
Managed Health Services (MHS Indiana) is implementing a new payment policy effective 9/29/2026 to address E/M overcoding in emergency department and office-based settings. Providers must review and validate that their billing and coding workflows align with the updated guidance to ensure compliant claims processing and accurate reimbursement under Medicare and Marketplace plans.
Action Required
Before September 29, 2026: (1) Billing team must obtain and review the complete Clinical & Payment Policies documentation from MHS Indiana at the provided resource link to identify specific E/M code restrictions or leveling requirements for ED and office-based encounters; (2) Validate all current billing workflows and coding practices against the new policy requirements, paying particular attention to Emergency Department E/M codes (CC.PP.076) and Office-based E/M codes (CC.PP.066); (3) Update billing software, encounter templates, and provider documentation guidelines to enforce policy compliance; (4) Train all billing staff, providers, and any billing vendors on the new requirements and any code-level changes; (5) Communicate changes to clinical teams to prevent claim denials due to overcoding. Contact MHS Indiana at (877) 647-4848 (Monday–Friday, 8:00 a.m.–8:00 p.m. EST) for clarification on specific coding requirements. Claims processed after 9/29/2026 that do not comply will be subject to denial or adjustment.