Forum - Questions & Answers

Jul 21st, 2015 - Sha12 62 

99205 vs 99215

We seen the pt for the first time in our office, so we billed 99205 (New Patient). Medicare denied the claim stating " Only one initial visit is covered per specialty/group. Can I rebill it as 99215 instead?

Jul 21st, 2015 - catclayton 6 

re: 99205 vs 99215

I believe you can only bill for 99215 if the PT is established. If the PT has been seen within the last 3 calendar years they would be considered established. Here are a couple of scenarios I have found myself in:

- The doctor sees PT's in the office and also sees PT's in the hospital. If your doctor has seen a PT in the hospital within the last 3 years - they are an established PT.

- If you have not been billing for this doctor for 3 calendar years, it is possible that the doctor has seen the PT and the last billing company didn't forward that info to you.

- If the PT was seen by another physician in your group within the last 3 years, this would also qualify them as an established PT.

I would call MED and ask them why they denied the claim. It could also very well have been denied in error.

Good luck!

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