WFassnacht
Contributor
Is medical decision making still the overarching factor when you go to determine your level of care. If this has changed can you please provider me with a website.
30.6.1/Selection of Level of Evaluation and Management Service
A - Use of CPT Codes
Advise physicians to use CPT codes (level 1 of HCPCS) to code physician services,
including evaluation and management services. Medicare will pay for E/M services for
specific non-physician practitioners (i.e., nurse practitioner (NP), clinical nurse
specialist (CNS) and certified nurse midwife (CNM)) whose Medicare benefit permits
them to bill these services. A physician assistant (PA) may also provide a physician
service, however, the physician collaboration and general supervision rules as well as all
billing rules apply to all the above non-physician practitioners. The service provided
must be medically necessary and the service must be within the scope of practice for a
non-physician practitioner in the State in which he/she practices. Do not pay for CPT
evaluation and management codes billed by physical therapists in independent practice
or by occupational therapists in independent practice.
Medical necessity of a service is the overarching criterion for payment in addition to the
individual requirements of a CPT code. It would not be medically necessary or
appropriate to bill a higher level of evaluation and management service when a lower
level of service is warranted. The volume of documentation should not be the primary
influence upon which a specific level of service is billed. Documentation should support
the level of service reported. The service should be documented during, or as soon as
practicable after it is provided in order to maintain an accurate medical record.