# New vs est pt /3 year rule-NOT MEDICARE



## taps15 (Jun 7, 2010)

We have a question regarding the new patient vs. established/three year rule for Non-Medicare Patients. It is the same question below that we found on the NGS Medicare website from a teleconference, they had in 2010 and posted it on 3/3/2010 and they gave their reply below. 

However, does this apply to non-medicare patients 

http://www.ngsmedicare.com/content.aspx?CatID=2&DOCID=21821

New vs. Established/Three Year Rule

We have new physicians joining our practice from other practices. For example, we have a new orthopedist. He saw a particular patient in his previous practice *under a different tax ID, *within the three year limit. When he sees the patient for the first time within our practice, *can we bill it as a new patient? *

Medicare's Answer: The new patient rule is based on the physician who renders the service. If this physician has seen the patient within the past three years, even in a different practice, this does not represent a new patient visit.


Remember I would like to know if this is only a Medicare Rule?

Thank you Toni P


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## cheermom68 (Jun 7, 2010)

*New vs. established*

This is a CPT guideline, so it should be followed by all payers.  You can find the guideline in the CPT book just before the E&M codes under E&M Services Guidelines, then under New and Established Patient.  They also provide a decision tree for new vs established.
So to answer your question this would be an established patient whether they are Medicare or not.


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