Medicare Compliance & Reimbursement

Unfortunately, RNs don't make the cut under CPT®'s new definition. If you've wondered what "other qualified healthcare professional" means when you see it in a code descriptor, such as 90460-90461 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional ...). If your MAC follows CPT® rules, you can exclude registered nurses from that list. At the request of many physicians, CPT® 2012 now defines the terminology. Don't Miss Errata Clarifications Although this definition didn't make it into the 2012 manual, the AMA lists it as part of the "CPT® 2012 Errata" on its Web site (www.ama-assn.org/resources/doc/cpt/cpt-2011-corrections.pdf) and the definition is as follows: "A 'physician or other qualified health care professional' is an individual who by education, training, licensure/regulation, and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports [...]