Wiki Self-pay vs insurance

[REGINALD068]

Hello
I had a patient come in for PT treatment, and at the time he was uninsured, so he was considered a cash pay patient, or self-pay. A little over a year later, he returned and had insurance. Would an established patient visit be billed, or a new patient visit? My answer is a new patient visit, because he didn't have any when he was initially treated, so how can you bill a Carrier for an established visit?

Thanks
Annoyed with Non Billers not staying in their lane

 

[CodingKing]

New vs established is solely based on patient being seen in the last 3 years (Same practice, specialty, sub specialty), not who the payer was at the time they were last seen. You don't get to bill a new patient just because patient now has insurance. Patient is considered existing.

Now if you are looking at 97001 vs 97002, that's not based on established vs new patient.

 

[hopepg]

Agree with CodingKing. It would be the same if an existing/established patient changes from one insurance to another.
Another way to possibly look at it - you have likely received a new patient fee/reimbursement from a payer (patient or insurance) within the last 3 years.