Annual Nursing Facility Assessment
March 17th, 2010 - Codapedia Editor
CPT® code 99318 is used to bill an annual nursing facility assessment. It requires three of three of these components: a detailed interval history, a comprehensive exam, and low or moderate medical decision making.
This visit is payable once per year for a resident in a nursing facility.
It may be used as one of the mandated nursing facility visits. Medicare does not expect a provider to bill this service in addition to a mandated, subsequent nursing facility visit when the annual assessment is performed at the time of the mandated visit. Here is what the Medicare manual says about this:
Beginning January 1, 2006, the new CPT® code, Other Nursing Facility Service (99318),
may be used to report an annual nursing facility assessment visit on the required schedule
of visits on an annual basis. For Medicare Part B payment policy, an annual nursing
facility assessment visit code may substitute as meeting one of the federally mandated
physician visits if the code requirements for CPT® code 99318 are fully met and in lieu of
reporting a Subsequent Nursing Facility Care, per day, service (codes 99307 – 99310). It
shall not be performed in addition to the required number of federally mandated
physician visits. The new CPT® annual assessment code does not represent a new benefit
service for Medicare Part B physician services.
The service may be performed by either an MD or a qualified Non-Physician Practitioner (NPP), but may not be billed as a shared service or incident to service.
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
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