Medicare_Carriers_Manual / 15507 / 15507

Why This Topic Matters

Emergency department visit reporting can depend on where the patient was seen, whether the visit was related to an emergency condition, and how care is divided among clinicians. Understanding the Medicare manual’s guidance helps billing and coding teams avoid inappropriate claim submission and better align reporting with facility setting and same-day service rules.

Article Sections

1. 15507. Emergency Department Visits (Codes 99281-99288)

   Overview of Medicare carrier policy for emergency department visits and related evaluation and management reporting. The section addresses setting, physician participation, same-day services, and interactions with other service types.

2. Use Of Emergency Department Codes By Physicians Not Assigned To Emergency Department

   General guidance on physician eligibility to report emergency department services when treating a patient registered in the emergency department.

3. Use of Emergency Department Codes In Office

   Discussion of site-of-service limitations and when emergency department reporting is not appropriate outside the emergency department setting.

4. Use of Emergency Department Codes To Bill Non-Emergency Services

   Guidance on reporting emergency department services when the visit is not for an emergency condition but occurs in the emergency department.

5. Emergency Department or Office/Outpatient Visits On Same Day As Nursing Facility Admission

   Policy on same-day emergency department or office/outpatient encounters in relation to nursing facility admission and associated payment treatment.

6. Emergency Department and Critical Care Services Provided on the Same Day

   Cross-reference to related Medicare guidance for same-day emergency department and critical care services.

7. Physician Billing For Emergency Department Services Provided To Patient By Both Patient’s Personal Physician and Emergency Department Physician

   Instructions for situations where both the patient’s personal physician and the emergency department physician evaluate the patient during the same episode of care.

8. Reporting of Visit When Patient Is Seen In Emergency Department and Emergency Department Physician Requests Another Physician To See the Patient In Emergency Department Or Office/Outpatient Setting

   Guidance on how to report encounters when the emergency department physician requests another physician’s evaluation and how the resulting service category is determined.