Effective 1/1/24 DCH will allow the reporting of E&M codes 99202-99205 and 99211-99215, when also reporting a preventive visit when providing a preventive health visit code 99381-99385 or 99391-99395 for children enrolled in Medicaid & PeachCare for Kids® (PCK)-eligible children. If a problem/abnormality is found during a preventative health visit and is significant enough to require additional work to perform the key components of a problem-oriented E&M service, then the appropriate Office/Outpatient code 99202-99205, 99211-99215 – along with the EP and 25 modifier – should also be reported. Prior to this, DCH/Medicaid policy limited reporting to no higher than a 99212 with a well visit. However, through Chapter advocacy we were able to lead DCH/Medicaid to update its policies to reflect new coding guidelines within Medicaid Fee for Service the three Georgia Medicaid Care Managment Organizations.
