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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: 01/28/2022
Behavioral/Mental Health Services
Behavioral/Mental Health Services Please explain the parameters for mental health services delivered via telehealth to a beneficiary who is at home. Note: CMS has extended the PHE-period waiver for in-person visit requirements for [...]
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Posting Date: 01/27/2022
Chronic Care Management
Chronic Care Management The guidelines state moderate or high complex MDM. Do the E/M guidelines apply here? Answer: Yes, the E/M guidelines for MDM are applicable, since chronic care management (CPT 99490) is included within the E/M [...]
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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
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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