Forum - Questions & Answers

Oct 2nd, 2013 - rphelps 615  1 

New patient vs established

Provider leaves one group and goes to another. If he takes a patient he recently saw in the old group is that patient new to the new group?

Oct 2nd, 2013 - agent00711   151 

re: New patient vs established

Per CPT® guidelines, a new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice , within the past three years.

Oct 2nd, 2013 - nmaguire   2,606 

re: New patient vs established

No, Established if seen within 3 years.

Oct 2nd, 2013 - nmaguire   2,606 

re: New patient vs established

Q10. Doctor A is new to our group. If a former patient sees Doctor A under our group, is this patient new or established?
If Doctor A sees his/her former patient, the service is an established patient visit. Doctor A's NPI shows the provider has seen the patient within the previous three years.
http://www.wpsmedicare.com/j5macpartb/resources/provider_types/2009_0727_newpatientservices.shtml

CPT® does not set reimbursement rules



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