Anthem Brings the ED Leveler to Ohio Medicaid

Anthem's August provider newsletter for Ohio announced a new reimbursement policy and gave it a policy number from 2019.

G-19002 is not new. It has run on Anthem's Medicare Advantage book across twelve states since September 1, 2019, survived reviews in 2021 and 2024, and carries a "no changes" note on the last one. What changed on August 1 is the line of business. Beginning with dates of service on or after November 1, 2026, Emergency Department: Leveling of Evaluation and Management Services applies to Ohio Medicaid Managed Care.

That is 92 days of notice on a policy that reprices the single highest-volume facility code family you bill.

The mechanism is short enough to quote in full. Anthem "will determine the level of ED E/M code by classifying the intensity and/or complexity of resources or interventions a facility uses to furnish all services indicated on the claim." When the submitted level runs above the level that classification supports, three remedies are on the table: the claim is not processed and comes back for resubmission at a lower level, reimbursement is adjusted down, or money already paid is recouped.

What Gets Read, and What Does Not

The scope is ten codes: 99281 through 99285 for Type A emergency departments, and G0380 through G0384 for Type B.

The definitions in the policy do the real work, and they are narrower than they look:

• Interventions are "the staff the facility utilizes and their work performed."
• Resources are the "facility building, equipment, and/or supplies utilized."
• And the line that decides most disputes: "Professional provider services are not considered facility interventions or resources."

So the emergency physician's medical decision making, the thing that sets the professional level under the 2023 E/M revisions, sits explicitly outside the read. What counts is what the facility did, as shown on the claim.

Your ED physicians can document a textbook high-complexity encounter and it will not move the facility level, because the classifier never sees it.

Anthem also says it is reading "all services indicated on the claim." That puts the whole evidence base on the claims surface.

The ancillaries, the supplies, the procedures you did or did not code alongside the E/M line are what the classifier weighs.