99211 With Medical Assistant


Gig Harbor, WA
Best answers
My physician believes we cannot bill CPT 99211 for our medical assistant to teach a patient to give self-administered injections because the MA is not a licensed nurse (LPN or greater). I am not able to find any CMS (or otherwise) documentation that regulates this. What do any of you know?
This article can be read at web site http://www.aafp.org/fpm/20040600/32unde.html#5 it is from the American Academy of Physicians. This may help.
The article is entitled Understanding when to use 99211.

The presence of a physician is not always required. Although physicians can report 99211, CPT's intent with the code is to provide a mechanism to report services rendered by other individuals in the practice (such as a nurse or other clinical staff member). According to CPT, the staff member may communicate with the physician, but direct intervention by the physician is not required.

Medicare's requirements on this point are slightly different: While the physician's presence is not required at each 99211 service involving a Medicare patient, the physician must have initiated the service as part of a continuing plan of care in which he or she will be an ongoing participant. (To some carriers, this means that the physician must see the patient at least every third visit.) In addition, the physician must at least be in the office suite when each service is provided. The reason for this difference is that Medicare considers these services to be an integral although "incidental" part of the physician's professional service. According to Medicare and most third-party payers, incidental services should generally be reported under the name and billing number of the physician or other professional in the office suite when the service is provided. Note, however, that the services can also be billed "incident-to" other health professionals, such as physician assistants or nurse practitioners. [For more on incident-to billing, see "The Ins and Outs of 'Incident-To' Reimbursement," FPM, November/December 2001, page 23.]