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Primary Care exception Rule

  1. #1
    Default Primary Care exception Rule
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    Hello can some clarify for me.... Should the Primary care exception rule be followed regardless of payer (Medicare vs BCBS) or is it not needed for private insurances?

  2. #2
    Milwaukee, WI
    Default Primary Care Exception

    The Primary Care Exception is a Medicare billing guideline. Medicaid, since it is state-run, may have different requirements. Commercial payers may have different requirements yet. Unfortunately, you need to do your research on the requirements of at least all of the major payers in your practice.

    I hope this helps!
    Shelly L. Kubacki, BS, MPA, CPC., CPMA

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