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Cotiviti EM Leveling Effective 7/15/2026
Effective date
Jul 15, 2026
Identified
Aug 26, 2026
Summary
Effective 7/15/2026, Absolute Total Care (Cotiviti) will implement an E&M leveling program that reviews and recodes high-level Evaluation and Management services based on diagnostic information and CMS/AMA guidelines. Providers must ensure E&M documentation aligns with CPT Manual and CMS Documentation Guidelines for E&M services, or claims may be downleveled to lower reimbursement rates.
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What to do
Action · 4 steps
01Billing and Clinical Teams must review AMA CPT Manual and CMS Documentation Guidelines for Evaluation and Management services to understand E&M code selection criteria.
02Providers must audit current E&M coding practices and ensure documentation supports the E&M level billed—specifically for high-level codes (99214, 99215, 99213, etc.)—as claims will be reviewed and potentially downleveled based on diagnostic information and peer risk adjustment.
03Update EMR templates and encounter forms to prompt providers for complete documentation of medical decision-making, history, and examination components that justify E&M level selection.
04Establish internal monitoring process to identify high-coding practitioners and provide targeted education.
If missed: Failure to comply will result in claim recoding to lower E&M levels and reduced reimbursement.
Original notice
Cotiviti EM Leveling Effective 7/15/2026
ambetterhealth.com · Always check the source before changing claims.