The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) updated coding and guidelines for office or other outpatient evaluation and management (E/M) services. These changes became effective January 1, 2021. These include new criteria for selecting the appropriate E/M level. We encourage you to review CMS's MLN Matters article on these changes and to take advantage of the educational tools and resources, opens new window available from the AMA.

While the AMA and CMS guidance is aligned on most of these changes, the two entities created CPT® code 99417 and HCPCS code G2212, respectively, to report prolonged services. Humana plans only allow HCPCS code G2212 to report these prolonged services. All applicable requirements CMS has established for the billing of HCPCS code G2212 must be met.

Humana is excited to announce that we recognize the new coding and guidelines for our Medicare Advantage, commercial and select Medicaid plans. When the AMA and CMS differ in their coding and guidelines, Humana plans follow the CMS guidance.