Question: A new provider has just joined our practice, and a number of patients that had been with her at her old practice have come with her and are now seeing her here. Since the provider is with a new practice, and this is the first time these patients are being seen at this practice, should the patients be regarded as new or established patients?
Codify Subscriber
Answer: CPT® defines “an established patient [as] one who has received professional (face-to-face) services from the physician/qualified healthcare professional or another physician/qualified healthcare professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.”
In other words, providing the patients in question have received services from your new provider within the previous three years, regardless of the location in which those services were performed, they would be regarded as established patients. They would also be regarded as established if they were seen by any other physician/qualified healthcare professional (QHP) in your office who practices in the same specialty and/or subspecialty as your new provider.