Answer: Initial critical care services (represented by CPT 99291) are not subject to split/shared rules and can only be billed by one provider, who performs and bills the entire service. In a group, same-specialty group members may contribute toward CPT 99291 time over a 24-hour period. Since NPPs are not of the same specialty as other physician group members, time counted toward CPT 99291 cannot be cumulative for services performed collaboratively or in sequence by physicians and NPPs.
Episodes of continuing/subsequent critical care, represented by CPT code 99292 may be performed and billed by other group members, including NPPs.
Each line of service must clearly indicate the rendering provider’s identifying information, especially given the variation between MD and NPP reimbursement. This information would need to be provided in Item 24 or the electronic equivalent. Revised 4/18/2019
When two members of a group (either physician or NPP) perform and bill CPTs 99291 and subsequent episode(s) of 99292 on the same date of service, do both services have to be billed on the same claim?
Answer: CPT code 99292 is an add-on code, used with primary code 99291, when appropriate. In these situations, NGS claim editing logic reviews all claims for the same date of service as the primary code. When 99291 has been billed and allowed for that date of service, 99292 would be payable, if all other claim requirements were met. Although the NPI on the two claims will vary when the codes are performed by different group providers, the two services are payable to the group. Added 4/18/2019