Wiki New Pts VS Est Pt when seeing PA's in different specialities same tax ID's....?

[twalls]

I have called Medicare multiple times now and am told the same thing. They do not look at subspecialty. So if a patient saw a PA in another practice (same tax ID/NPI) they will not pay another new patient visit. Years ago Medicare would look at taxonomy, but they no longer do that. Is this correct? So if a patient is seeing a peds PA as a new pt then is referred to ortho and sees the PA, they are established? Correct?

Thank you, as always!

 

[mdeleon]

No. The definition of a new patient is one who HAS NOT received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice within the past three years. The patient would be a new patient for both visits.

 

[katemae84]

My understanding is that yes, you're correct. The patients would be considered established even though the PAs are practicing in different specialties. Medicare recognizes PAs & NPs as their own specialty types (PAs are enrolled with Medicare as a specialty type of 97, NPs are enrolled with Medicare as a specialty type of 50- see the sections on PA & NP billing in the Medicare Claims Processing Manual- Chapter 12: Physicians/Nonphysician Practitioners).
That's why Medicare will deny more than one new patient visit if two PAs working for the same entity see a patient, even if the PAs are practicing in two different specialty group practices.
It works the same way with NPs.