Pennsylvania’s average evaluation and management (E&M) code reimbursement is lower than many other states in the region, according to a report from the Pennsylvania Medical Society (PAMED).
Pennsylvania E&M code reimbursement generally ranks about fifth or sixth among seven surrounding states—New Jersey, Maryland, Delaware, New York, Ohio, West Virginia, and Virginia.
PAMED compared reimbursement for 15 select E&M procedure codes in these states.
For new patient office visits (code 99201) in 2009, Pennsylvania ranked lowest with an average reimbursement of $35, while Delaware ranked highest at $66.25.
For office or other outpatient visits at which the patient presents with moderately severe problems (code 99203), Pennsylvania ranked seventh, with an average reimbursement of $83.57. Delaware again ranked highest with reimbursement of $106.25.
For established patient office visits when the patient presents with problems of low to moderate severity (code 99213), Pennsylvania ranked third with an average reimbursement of $66.25. West Virginia was lowest at $43.33, and Delaware was highest at $86.25.
For new or established consultations (code 99242), Pennsylvania ranked third with an average reimbursement of $93.33. Virginia was lowest at $65, and Delaware was highest at $143.33.
Pennsylvania was on the low end for Medicaid reimbursement as well.
The report was one of three that resulted from a resolution at PAMED’s 2008 House of Delegates. Read the full reports.