Methodology & limitations
Evidence you can trace. Uncertainty you can see.
The source matters as much as the status. Here’s what this resource tracks, what each label means, and what still needs review.
What’s included
This initial resource contains independently researched payer documents, short summaries, and draft instruction records. It does not yet cover all states, all plans, or every payer announcement. Counts describe this dataset only. A state-program record does not count each managed care organization as a separately verified payer.
Evidence status describes the source. Clinical review status describes Ember’s review of the interpretation. Billing instructions currently await certified coder review. Draft rules cannot produce encounter recommendations.
How to read the status labels
- Confirmed 2027 guidance
- The cited payer document provides 2027 instructions. It may still leave implementation details open.
- Proposed, not final
- A proposal has been published; final payer instructions are not established.
- Pending payer guidance
- The payer’s source indicates further guidance is pending.
- Awareness notice only
- The payer has announced the change, without enough operational detail to establish an encounter rule.
- Current policy only
- The cited document describes existing policy and does not establish a 2027 transition.
Review and freshness
- Start with a primary payer or government source. Record its publication date, link, scope, and the date it was checked.
- Keep source text separate from interpretation. Short quotations link back to the full document; unstated dates and instructions remain unknown.
- Before public launch, a qualified coding reviewer must approve each billing interpretation. Confirmed guidance requires two attributed reviewers.
- Keep a history of record changes. Initial additions are not presented as payer policy changes. Sources older than 30 days are flagged for recheck.
The current release is a dated snapshot. Automated source monitoring, email digests, emailed reports, and CRM synchronization are not active. Check the linked primary source for changes after the evidence date.
A code-family transition, not a one-to-one conversion
| Legacy examples | 2027 direction |
|---|---|
| 59400, 59510, 59610, 59618 | Separate the care phases; no single replacement package. |
| 59425, 59426 | Encounter-level E/M; select using the applicable guidelines. |
| 59430 | Encounter-level E/M, subject to delivery-day rules. |
Code numbers are references only; this is not a substitute for the licensed code set. Read the AMA’s full change list and guidelines.
Privacy and sharing
The encounter checker is for hypothetical cases. It runs in your browser and has no patient identifier fields. Its share button encodes the hypothetical inputs in a URL fragment, which is not included in the HTTP request to the site. Anyone receiving that link can see those inputs.
To view readiness results, submit your work email, organization, and assessment answers. Refreshing starts a new assessment. Contact and feedback forms must not include patient or claim information. For payer policy alerts, email our team about Ember’s payer policy product.