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Posting Date: 03/18/2022
Consultations
Consultations Does CMS permit payment for consultative E/M services? Answer: CMS permits payment for medically necessary consultative E/M services. The specific E/M codes previously used to represent consultative services were [...]
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Posting Date: 01/28/2022
Critical Care Services
Critical Care Services Please define the time requirement for billing CPT code 99292. Answer: Whether critical care is performed by a single provider or on a split (or shared) basis, the time requirement for CPT code 99292 remains the [...]
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Posting Date: 01/27/2022
Documentation
Documentation What are the basic documentation requirements for a service submitted to Medicare for payment? Answer: For all services submitted to Medicare, the medical record (whether electronic or paper) must clearly define the provider [...]
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Posting Date: 01/27/2022
Examination
As of 1/1/2023, CMS has eliminated prior specifications for the scope of examination and associated documentation in the outpatient office and hospital settings. The provider is expected to perform and document a medically necessary and [...]
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Posting Date: 01/28/2022
Fee-For-Time Compensation Arrangements
Fee-For-Time Compensation Arrangements Can a physician return to work in his or her practice for a short period of time to reset the 60-day clock requirement for the fee-for-time compensation arrangement provider? Answer: In order for the [...]
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Posting Date: 01/27/2022
General E/M Information
General E/M Information Please explain the terms “auxiliary personnel” and “clinical staff” in the context of Medicare services. Answer: These terms are often used in defining which staff members can perform Medicare services [...]
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Posting Date: 01/27/2022
Global Period Services
Global Period Services Is it permissible for providers (physicians or NPPs) other than the primary surgeon to bill for preoperative or postoperative care within a global period? Answer: The global surgery fee is paid to the primary [...]
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Posting Date: 01/28/2022
Admission and Discharge Services
Admission and Discharge Services Is it permissible for an NPP to perform an initial hospital admission or discharge service on behalf of the attending physician, or on a split/shared basis, when both are members of the same provider [...]
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Posting Date: 01/27/2022
Advanced Care Planning
Advanced Care Planning Please define documentation requirements when billing advanced care planning (CPT 99497 and 99498). Answer: ACP codes may be used with or without a base E/M code on the same date of service, based on whether a [...]
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Posting Date: 02/21/2020
IPPE and AWV Services
IPPE and AWV Providers are reminded that the IPPE and AWV are Medicare-covered services within their own benefit category. As such, they are not subject to standard “incident to” billing guidelines and must be billed by the performing [...]
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Posting Date: 10/26/2022
Nonphysician Practitioner Services
Nonphysician Practitioner Services In addition to the frequently asked questions below, please view NGS’ Nonphysician Practitioners-Reducing Costly Appeals; Increase Provider Revenue article for related information. Is it permissible for [...]
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Posting Date: 01/28/2022
Preoperative Clearance
Preoperative Clearance What requirements must be met for a preoperative clearance visit to be considered medically necessary and billable? Answer: CMS does not set requirements for medical clearance; these are established by individual [...]
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Posting Date: 01/28/2022
Provider Specialty
Provider Specialty Should each MD in the same practice bill with two different taxonomy codes based on whether functioning as a cardiologist or electrophysiologist? Answer: Yes, providers should be billing with their taxonomy codes. The [...]
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Posting Date: 01/31/2015
Ambulance Transports Included in SNF Consolidated Billing
Ambulance Transports Included in SNF Consolidated Billing Transport Description Medical Necessity Met Ambulance Billing Modifiers and Other Considerations Who is Responsible for Payment? Reference(s) SNF to [...]
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