• The services must be furnished in a primary care center located in the outpatient department of a hospital or another ambulatory care entity in which the time spent by residents in patient care activities is included in determining DGME payments to a teaching hospital. This requirement is not met when the resident is assigned…

Medicare may grant a primary care exception within an approved GME Program in which you, the teaching physician, are paid for certain E/M services the resident performs when you are not present. The lower and mid-level E/M services included under the primary care exception are given below. New Patient CPT 99201    Office or other outpatient…

Billing Guidelines For Screening For chlamydia And Gonorrhea Pregnant women who are 24 years old or younger when the diagnosis of pregnancy is known and then repeat screening during the third trimester if high-risk sexual behavior has occurred since the initial screening test. Pregnant women who are at increased risk for STIs when the diagnosis…

For a given encounter, the selection of the appropriate level of E/M services is determined according to the code of definitions in CPT books and any applicable documentation guidelines. CPT books are available from the American Medical Association. When a Teaching Physician bills for E/M services, he or she must personally document at least the…

Measure # 241 Ischemic Vascular Disease (IVD):   Complete Lipid Panel and Low Density Lipoprotein (LDL-C) Control Measure # 245 Chronic Wound Care: Use of Wound Surface Culture Technique in Patients with Chronic Skin Ulcers Measure # 246 Chronic Wound Care: Use of Wet to Dry Dressings in Patients with Chronic Skin Ulcers Measure # 247…

Florida Medicaid reimburses for services rendered by licensed, Medicaid-participating Advanced Registered Nurse Practitioners (ARNPs). The services must be rendered in collaboration with a physician. Reimbursement for anesthesia, obstetrical and psychiatric services is limited to ARNPs who have completed the educational program in the appropriate specialty and are authorized to provide these services. Medicaid reimburses ARNPs who are Medicaid-participating…

Services furnished in teaching settings are paid through the Medicare Physician Fee Schedule (PFS) if the services are: • Personally furnished by a physician who is not a resident; • Furnished by a resident when a teaching physician is physically present during the critical or key portions of the service; or • Furnished by a…

Home health services are provided in a recipient’s home or other authorized setting to promote, maintain or restore health or to minimize the effects of illness and disability. Medicaid reimburses for home health services rendered by licensed, Medicaid-participating home health agencies. Medicaid reimbursable services include: • Home visit services provided by a registered nurse or a…

The Department of Children and Families and the Social Security Administration determine Medicaid recipient eligibility. Two basic groups of people are eligible for Medicaid: 1) low income children and families and 2) the aged, blind and disabled. Within these two groups, there are several categories of eligibility. In addition to qualifying under one of these…

According to CMS Change Request 7737, Sub: Emergency Update to the CY 2012 Medicare Physician Fee Schedule Database (MPFSDB), the New HCPCS codes G0449 (Annual face to face obesity screening, 15 minutes) and G0450 (Screening for sexually transmitted infections, includes laboratory tests for Chlamydia, Gonorrhea, Syphilis, and Hepatitis B) previously released on the 2012 HCPCS…