Use Revenue Codes as EBP Codes in Service Loop 

Recently added requirements for Louisiana Medicaid payers require EBP (Evidence-Based Practice) codes to be added to both printed and electronic claims. This Knowledge Base article will guide you through the process of setting up your claims to include EBP Codes.

Navigate to Settings and Directories from the Chart Room, then to Group Level Settings (1). Click to go to the Service/Mod Codes tab (2).

In the Revenue Codes column (3), use the next available space to type in the EBP code, such as “EB01”, “EB02”, etc. You do not need to enter a Rate and Description.

Next, find all qualifying codes in the Service Code Short List column (4) and use the Revenue Code dropdown box to assign an EPB code to the service code.

In the Insur Payers tab of Group Level Settings + Directories, select the Medicaid payer from the Insurance Payer Short List, and then click into the Professional Payer ANSI/NUCC tab to display a list of available options

Click to check the rule for ‘Use Revenue Codes as EBP Codes in Service Loop’. 

Don’t forget to click the Save button when finished making changes.

The service code(s) is/are now associated with the accompanying EBP code. No additional setup is required. When a note with a qualifying service code is prepped in the Billing/Productivity report for either paper or electronic submission, the assigned EBP code will be present in Box 19 of the CSM 1500, and Loop 2400 SV101-7 of the ANSI, respectively.

CMS 1500 detail

Note: The number preceding the EB code relates to the service code’s position on the CMS 1500. In this example, since the 90837 service code was applied to line 1 of the claim, the EB code is preceded by a 1. Likewise a qualifying code applied to line 3 of the claim would show a 3 preceding the EB code.

ANSI detail

The following valid CPT/HCPS codes will include the accompanying EBP code (when setup), and are subject to change:

H0036 with modifier HE, 90837, 90834, 90832, 90847, 90846

Note: If there is a revenue code for the service code selected, it will override ‘Corrected Claim’ information which typically goes into box 19 of the CMS 1500 form.