ED Coding and Reimbursement Alert
E/M Level and a Starred Procedure
Anonymous OH Subscriber
Answer: CPT states that when the starred procedure is carried out at the time of the initial visit and the procedure constitutes the major service at that visit, procedure number 99025 is listed in lieu of the usual initial visit as an additional service. Medicare carriers do not pay this code in any setting. Most insurance carriers consider 99025 to be a facility charge and will not pay for it in the ED. Code 99025 should not be used for ED visits because the code definition specifies initial (new patient) visit when starred surgical procedure constitutes major service and the ED site of service does not recognize new patient or established patient designations.
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