MedicaidBilling CodesMedium impact
PT 49-26: GE Modifier Clarification
Maryland Medicaid·MD · Family Medicine, Internal Medicine, Pediatrics +2 more·Managed Care
Effective date
Jan 5, 2026
We identified it
Jun 18, 2026
Summary
Maryland Medicaid clarifies that residents in GME programs with primary care exception can bill lower and mid-level E/M services (99202-99203, 99211-99213) using the GE modifier without teaching physician physical presence. Teaching physicians must still review care and can only use Medical Decision Making (not time) for visit level selection.
Action Required
Immediately: Teaching facilities with GME programs must ensure proper use of GE modifier for resident-provided services under primary care exception. Update billing software to accept GE modifier with specified E/M codes. Train billing staff that level 4-5 E/M visits cannot be billed under this exception and Medical Decision Making (not time) must be used for visit selection. Ensure teaching physicians document care review for all resident-provided services.