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We follow the South Carolina Medicaid Providers Manual in regard to emergency room (ER) services. Outside attending physicians will be paid for services in an ER setting when a hospital based ER physician is not available, when they are called in by the ER physician or when a life threatening situation develops. These providers can bill using the Office or Other Outpatient Services codes 99201- 99215, Office or Other Outpatient Consultations codes 99241-99245 or Emergency Department Services codes 99281-99285 as supported by the documentation.
Hospital salaried or hospital based ER physicians should bill on a CMS 1500 form. These services must be billed using the Emergency Department Services codes 99281-99288. Procedures identifiable as a unique and separate service may also be reported. Each level of service includes examinations, evaluations and treatments that are medically necessary and that are presented as an emergency in a hospital emergency room setting. We will only reimburse for one emergency room visit per day for the same or a related diagnosis.
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