Wiki List of recognized subspecialties

[mhstrauss]

Does anyone have a list (or link to any resources) of Medicare-approved/recognized physician subspecialties? This link is all I can find:

http://www.cms.gov/Medicare/Provide...iderSupEnroll/Downloads/TaxonomyCrosswalk.pdf

I have a few Neurologists that are making the argument that, since they have specific fellowships beyond general Neurology (Multiple Sclerosis, Movement Disorders, Sleep Disorders, etc), they would be able to bill a new patient visit for a Medicare patient who has been seen by another Neurologist in our group within the last 3 years. I want to find proof (preferably from CMS) that these are recognized subspecialties before I make any changes to our protocols.

Appreciate any help anyone can give, TIA!!

 

[ashlyn26]

https://taxonomy.nucc.org/?searchTerm=&x=5&y=15

This is an online search tool. It will tell you the different specialties & subspecialties. It tells you whether or not the subspecialty is recognized as different than the specialty. I know this is an old post, but just in case anyone has the same question.

 

[thomas7331]

Just an FYI - in my experience it's a real headache to get these kinds of new patients visits paid. One practice where I worked (under NGS Medicare) tried this and we ultimately decided that it wasn't worth it and went back to making these established patient visits. Let your physicians know that these visits are going to be denied and that you'll have to appeal every single one of them with documentation showing that the physicians are of different sub-specialties, which the payer appeals department may or may not accept. If your experience is like mine was, most likely your initial appeal will be denied and you'll have to go to a second level appeal. Your payments could be held up for months, with no guarantee that you'll get the denial overturned in the end. Think about whether or not it is really worth the few extra dollars that you get for a new patient visit to have your entire visit payment held up for this long, as well as incurring the costs of having your staff write, print, mail and track these appeals these and of all the time that these charges will be sitting on your accounts receivable. But if they really insist on doing this, my suggestion would be to try a few at first as a pilot and see how it goes.

 

[csperoni]

I would add on that while there are many more different taxonomy codes, Medicare uses only a 2 digit specialty code which is much more restrictive.

https://medicare.fcso.com/pe_resources/138372.asp

From my experience, commercial carriers will go by taxonomy codes. MACs use the 2 digit specialty code only.
Example from OB/GYN. Taxonomy subspecialties include all sorts of subspecialties (MFM, REI, FPMRS, just GYN). However, Medicare basically only recognizes obgyn and gyn oncology. The rest of the obgyn subspecialties fall under obgyn.
Here's a crosswalk from Medicare showing for some of their specialty codes, how many different taxonomies could fall into that 2 digit code.
https://www.cms.gov/medicare/provid...idersupenroll/downloads/taxonomycrosswalk.pdf
Working in gyn subspecialties (some Medicare recognized, some not), for a large healthcare system we typically bill as new for all insurances if seeing a fellowship trained, board certified subspecialist for the first time. If insurance denies, we try an appeal (standard form letter just plug in patient info and include NPI registration with subspecialty taxonomy). If appeal is denied, we resubmit as established. If one ob/gyn refers to another ob/gyn within the healthcare system who happens to specialize in a particular treatment, that gets billed as established.
There are certain types of groups (like ENT, ophthalmology, ortho, neuro) where doctors might often subspecialize in a particular field, body part, etc but is not a different specialty.