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AmbetterExchange · Billing Codes · Claims & Billing · IN · Emergency Medicine, General Practice, Family Medicine +1 moreHigh 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)

Effective date
Sep 29, 2026
Identified
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.

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What to do

Action · 8 steps
01Before September 29, 2026.
02Billing 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.
03Validate 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).
04Update billing software, encounter templates, and provider documentation guidelines to enforce policy compliance.
05Train all billing staff, providers, and any billing vendors on the new requirements and any code-level changes.
06Communicate changes to clinical teams to prevent claim denials due to overcoding.
07Contact MHS Indiana at (877) 647-4848 (Monday–Friday, 8:00 a.m.–8:00 p.m. EST) for clarification on specific coding requirements.
08Claims processed after 9/29/2026 that do not comply will be subject to denial or adjustment.

Original notice

New Payment Policy: Leveling of Care: ED E/M Overcoding for Professional Services (CC.PP.076) & Office-based E/M Overcoding (CC.PP.066)
ambetterhealth.com · Always check the source before changing claims.
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Related policy hubs

Ambetter policiesIN policy changesEmergency MedicineGeneral PracticeFamily MedicineInternal Medicine

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