MedicaidAdministrativeHigh impact
[Ohio] E/M services correct coding
Anthem BCBS·OH·Coding
Effective date
Sep 1, 2026
We identified it
Jun 13, 2026
Summary
Anthem BCBS Ohio will begin using analytics to review E/M claims for coding accuracy starting September 1, 2026. Claims coded at higher levels than peers will be selected for review and may be downgraded or require additional documentation to support the original coding level.
Action Required
Before September 1, 2026: Providers must ensure E/M coding strictly follows AMA CPT manual and CMS guidelines, coding only to the level needed for the patient's condition complexity. Billing team should review current E/M coding patterns and compare against peer benchmarks. Document medical decision-making complexity thoroughly in patient records to support level 4 and 5 E/M codes, as claims exceeding peer norms will be subject to review and potential downgrades.