TO: All Providers
RE: Rate Increase for Evaluation and Management (E&M) Procedure Codes
Effective October 1, 2022, the Alabama Medicaid Agency will increase the reimbursement rates for Evaluation and Management (E&M) procedure codes listed below. Rural providers will receive $1.00 more than the listed reimbursement rate. Additionally, these increases do not impact the Alabama Coordinated Healthcare Network (ACHN) Physician rates or Physician Bump rates.
E & M Procedure Codes
E & M Procedure Procedure Code Current Medicaid Reimbursement Rate Medicaid Rate Eff. 10/1/22 Reimbursement Description
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99202 Office o/p new sf 15-29 min $ 53.00 $ 64.61
99203 Office o/p new low 30-44 min $ 78.00 $ 91.85
99204 Office o/p new mod 45-59 min $ 111.00 $ 141.16
99205 Office o/p new hi 60-74 min $ 142.00 $ 178.70
99213 Office o/p est low 20-29 min $ 42.00 $ 63.95
99214 Office o/p est mod 30-39 min $ 67.00 $ 93.11
99215 Office o/p est hi 40-54 min $ 98.00 $ 125.40
99217 Observation care discharge $ 51.00 $ 63.28
99218 Initial observation care $ 48.00 $ 87.41
99219 Initial observation care $ 81.00 $ 118.90
99220 Initial observation care $ 113.00 $ 162.03
99221 Initial hospital care $ 49.00 $ 88.96
99222 Initial hospital care $ 81.00 $ 120.44
99223 Initial hospital care $ 113.00 $ 177.14
99224 Subsequent observation care $ 19.93 $ 34.72
99225 Subsequent observation care $ 35.48 $ 63.68
99226 Subsequent observation care $ 53.06 $ 91.62
99231 Subsequent hospital care $ 24.00 $ 34.43
99232 Subsequent hospital care $ 40.00 $ 63.39
99233 Subsequent hospital care $ 57.00 $ 91.33
99234 Observ/hosp same date $ 97.00 $ 116.85
99235 Observ/hosp same date $ 128.00 $ 148.06
99236 Observ/hosp same date $ 160.00 $ 190.67
99238 Hospital discharge day $ 51.00 $ 63.57
99239 Hospital discharge day $ 69.00 $ 93.35
For questions related to the E&M procedure code reimbursement rates, contact Gainwell Technologies Provider Assistance Center at 1-800-688-7989.
The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2022 American Medical Association and © 2022 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.