Maryland emergency department billing services
Professional ER billing for emergency medicine groups in Maryland: MDM-based 99281-99285 levels, critical care time, modifier 25, payer enrollment and No Surprises Act claims, built on the Maryland payer rules verified below.
What changes an ER claim in Maryland.
Every Maryland rule on file, each linked to its primary source: state surprise-billing law, Medicaid ER policy, Medicaid managed care, the Blue plan and the Medicare contractor.
| Rule type | Date | What it says | Source |
|---|---|---|---|
| State surprise-billing law | Jul 2011 | MD PPO/EPO: out-of-network hospital-based physicians who take assignment of benefits get paid in 30 days at no less than the greater of 140% of the insurer's average contracted rate for the area or its 2010 allowed amount inflated by MEI; patient owes only cost share. HMOs pay under HG s.19-710.1. | Source |
| Medicaid ER policy | Jan 2026 | Maryland Medicaid FFS 2026: trauma physicians treating State Trauma Registry patients in trauma centers are paid 100% of Medicare (POS 23 allowed); other ER providers are paid from the Professional Services Fee Schedule. | Source |
| Medicaid managed care | Nov 2019 | Maryland HealthChoice MCOs must pay hospital ER providers, with no prior authorization, for emergency services, the EMTALA medical screening exam, and MCO-directed ER care; MCOs pay at least Medicaid FFS for inpatient services and need not pay more than FFS. | Source |
| Medicare contractor | Jul 2021 | Medicare Part B ER professional claims in Maryland go to Novitas Solutions, Jurisdiction L (JL). | Source |
How we bill Maryland ER visits.
The same four-step workflow we run for emergency medicine and hospitalist groups billing from their hospital system.
Hospital feed and registration
Demographics, insurance and the attending physician arrive from the hospital system daily. Gaps go back to registration as clarification requests, not guesses.
MDM levels and critical care minutes
ED visits 99281-99285 are coded on medical decision making only. Critical care is 99291 for 30 to 74 minutes and 99292 from 104 total minutes, on documented time.
Modifier 25 and enrollment check
A separately identifiable E/M on the day of a procedure carries modifier 25 with its own documentation. The rendering physician is checked against the payer roster before release.
Submission, remit and NSA/IDR
Professional claims go out with place of service 23. Out-of-network ER claims follow the No Surprises Act: in-network cost share only, open negotiation, then federal IDR.
FAQ: ER billing in Maryland.
Does Maryland have a state surprise billing law for ER care?
MD PPO/EPO: out-of-network hospital-based physicians who take assignment of benefits get paid in 30 days at no less than the greater of 140% of the insurer's average contracted rate for the area or its 2010 allowed amount inflated by MEI; patient owes only cost share. HMOs pay under HG s.19-710.1.
What does Maryland Medicaid require for ED visits?
Maryland Medicaid FFS 2026: trauma physicians treating State Trauma Registry patients in trauma centers are paid 100% of Medicare (POS 23 allowed); other ER providers are paid from the Professional Services Fee Schedule.
How do Maryland Medicaid managed care plans handle ER claims?
Maryland HealthChoice MCOs must pay hospital ER providers, with no prior authorization, for emergency services, the EMTALA medical screening exam, and MCO-directed ER care; MCOs pay at least Medicaid FFS for inpatient services and need not pay more than FFS.
Which Medicare contractor processes Maryland ER professional claims?
Medicare Part B ER professional claims in Maryland go to Novitas Solutions, Jurisdiction L (JL).
How are emergency department visit levels chosen in Maryland?
By medical decision making only. CMS states that for emergency department visits practitioners use MDM, not time, to select 99281-99285, so the note must carry the problems addressed, the data reviewed and the risk of management.
Nearby ER billing state guides.
Neighbouring state pages with their own verified ER payer rules.