New patient codes 99201–99205 may be billed in an office, outpatient department or Emergency Department.
What is a new patient?
The CPT® and Medicare (CMS) definition are the same. From the CPT® book:
A new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years.
Location matters: seen by you, any location.
Specialty matters: seen by another physician of the same specialty designation. Specialty designation is a two-digit code used when you sign up CMS or other payor.
Time matters: past three years
Established patient visits, 99211–99215:
These visits can be billed in the physician office, outpatient department or Emergency Department. 99211 is a nurse visit, not typically billed by a physician, NP or PA. Use these for follow up services provided outside the global period.
Office and outpatient consult: 99241–99245
May be billed in the office or outpatient department
Inpatient consult: 99251–99255
Consults are not divided into new or established patient visits
Consults have strict documentation requirements
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