Effective February 1, 2026: Revised Payment Policy: Leveling of Care: Office-Based Evaluation and Management Over-coding
Date: 10/31/25
Superior HealthPlan presents a new Leveling of Care: Officed-based Evaluation and Management (E&M) Over-coding (CC.PP.066) payment policy. As a result, the following policy has been created, and is posted on Superior’s Clinical, Payment and Pharmacy Policies webpage for review, prior to its implementation.
Policy | Effective Date | Applicable Products | New Policy Overview or Updated Policy Revisions |
Leveling of Care: Office-based Evaluation and Management Over-coding (CC.PP.066) | February 1, 2026 | Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP | The purpose of this policy is to ensure that the level of E&M service reported by the provider reflects the services performed. When a provider submits an E&M service that exceeds the maximum level of E&M service based on the diagnosis and other claim documentation elements, the E&M code is reduced to reflect the maximum level of E&M service. The following services will be reviewed to validate correct coding:
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To review all clinical payment or payment policies, please visit Superior’s Clinical, Payment and Pharmacy Polices webpage.
For questions or additional information, please contact Superior Provider Services at 1-877-391-5921.