Provider updates

We are writing to inform you of an upcoming policy change affecting the billing of Evaluation and Management (E/M) services. We are making this change to better align with national coding standards and Centers for Medicare & Medicaid Services (CMS) guidance. This policy applies to services provided by chiropractic and acupuncture providers and will apply to all billed services processed on or after November 15, 2026.  

Providers may bill no more than 1 Evaluation and Management service every 30 calendar days for the same member and for the same diagnosis.

• This limitation applies to established patient CPT codes 99211–99215.
• A claim will be denied if the same provider bills another E/M visit for the same member and the same diagnosis within 30 calendar days of a previous E/M visit. The previous visit may have been billed as a new patient visit (99202-99205) or an established patient visit (99211-99215). 

For billed services processed on or after November 15, 2026, Evaluation and Management (E/M) codes billed by a provider will be automatically denied when billed within 30 calendar days of a previously billed E/M service.

We appreciate your diligence in adhering to national coding standards, CMS and Medicaid policies, and standard billing practices. Your efforts assist in ensuring appropriate and accurate billing and reimbursement. You can find the relevant coding guides on our website at link.careoregon.org/coding-guides

If you have any questions or require additional clarification, please contact CareOregon Provider Relations:

• CareOregon/Health Share: Metroprs@careoregon.org
• Jackson Care Connect: jacksonprs@careoregon.org
• Columbia Pacific CCO: colpacPRS@careoregon.org