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Thread: Primary Care Exception

  1. #1

    Default Primary Care Exception

    AAPC: Back to School
    Your help is needed in regards to the Primary Care Exception of Teaching Physician guideline for Medicare. It is my understanding that under the Primary Care Exception we are only allowed to bill for services of 99201-99203 and 99211-99213. Any other service than those do not fall under the primary care exception and would be subject to the Teaching Physician guidelines (ie, if the teaching physician was not present/did not see the pt and the resident performed 99214 or 99215 this service would not be billable). If you agree or disagree please provide valid documentation guidelines. Thanks a bunch for your input.

  2. #2
    Join Date
    Apr 2007

    Smile bsuse

    yes, that is correct. the 99214, and 99215 cannot be used under those guidelines. the teaching physician must be present for the higher level
    evals and all invasive procedures. if the patient presents with more
    complex issues during a session in which the teaching doc meets the criteria for billing under the 'primary exception', the teaching doc may bill for the higher code using the GC modifer, showing that the 'teaching physician policy' was applied during that instance and not the 'primary care exception'.
    this is per AAPC study guide module 6, 2003.

  3. #3
    Join Date
    Apr 2007


    So, is a Level 4 visit documented by a resident under the Primary Care Exception UNBILLABLE when the teaching physician is not present? Or, may we bill the visit as a Level 3 and provide feedback to the resident and teaching physician regarding the PCE rules? What are other clinics doing out there? Thanks in advance for your responses.

  4. #4


    I just posted a similar question....anyone familiar with this?

  5. #5


    Can anyone help with this?

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