Reimbursement Guidelines for Facility Evaluation and Management Charges
2026/2/4
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Posted by Provider Relations
Fidelis Care would like to inform providers that evaluation and management (E&M) services billed on a facility claim with treatment room revenue codes are not eligible for reimbursement. Evaluation and Management procedure codes represent the professional service – the physician or qualified provider’s time, assessment and decision- making.
Treatment room revenue codes (760, 761 and 769) represent the facility charge for use of space, supplies, and staff for treatment or observation of a patient. Treatment rooms are typically used when a therapeutic or diagnostic procedure (e.g., an infusion, injection wound care) is performed, not when the visit consists primarily of evaluation and management services. If both an evaluation and management service and a treatment room revenue code are reported for the same patient encounter, it constitutes duplicate billing for overlapping resource utilization.
Billing Guidelines:
Claims submitted with revenue codes 760, 761 and 769 in combination with E/M services will be reviewed according to the application criteria in this Payment Policy.
For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To identify your designated representative, please visit Contact Your Designated Provider Relations Specialist.