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
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
In a significant announcement on February 11, 2019, HHS proposed new rules aimed at improving interoperability of electronic health information. This announcement was made in support of the MyHealthEData initiative which was announced by the Trump administration on March 6, 2018. The goal of that initiative was to break down ...
Some providers mistakenly think that they cannot bill a missed appointment fee for Medicare beneficiaries. You can, but Medicare has specific rules that must be followed. These rules are outlined in the Medicare Claims Policy Manual, Chapter 1, Section 30.3.13. You must have an official “Missed Appointment Policy” which is ...
Are you aware if digital x-ray of the spine requires a different code than plain x-ray? If so, where can I find the information specific to digital x-ray codes?
There are no separate codes for digital x-rays. However, there may be modifiers that are required to be submitted with the usual ...
State scope of practice laws and regulations will help determine who is considered Clinical staff and Other qualified Health Care professionals.
Physician or other qualified healthcare professionals: Must have a State license, education training showing qualifications as well as facility privileges.
Examples of Qualified Healthcare professionals:
(NOTE: this list is not all-inclusive, please refer to your payer ...
We are excited to announce BC Advantage is now offering Q-Pro CEUs! It is now even easier to get your QPro CEUs and stay current with BC Advantage: offering news, CEUs, webinars and more. BC Advantage is the largest independent resource provider in the industry for Medical Coders, Medical Billers,...
Physicians often use the term "attestation" to refer to any kind of statement they insert into a progress note for an encounter involving work by a resident, non-physician practitioner (NPP), or scribe. However, for compliance and documentation purposes, "attestation" has a specific meaning and there are distinct requirements for what ...
It is not unusual for a healthcare provider to review x-rays taken and professionally read by another entity. Questions arise regarding how to bill this second review. It is essential to keep in mind that the global (complete) service of taking an x-ray is composed of both a professional and ...