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Allied Providers and New Patient Visits

  1. #1
    Question Allied Providers and New Patient Visits
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    In the CPT book it states, "A new patient is one who has not received any professional services from the PHYSICIAN or another PHYSICIAN of the same specialty who belongs to the same group practice, within the past three years." How do NP and PA fall into this category? Can they never charge out a new patient visit since they are not a Physician?

  2. #2
    Milwaukee WI
    Default Billing under their own NPI
    If they are billing under their own NPI they most certainly can charge for a new patient visit IF no supervising physician of the same specialty/practice has seen the patient in the last 3 years.

    Because the reimbursement for allied health professionals is frequently lower than for physicians performing the exact same service, many practices have a policy of requiring all new patients to be seen by physician for the first visit.

    On the other hand, in some specialties using the NP or PA for the first visit makes a great deal of sense. As an example, I went to a dermatology practice as a new patient. When I called to make the appointment I was told I could wait 3 months for an appointment with an MD; or I could see the PA in two weeks. I saw the PA. She was perfectly qualified to evaluate and prescribe a treatment plan for my issue. The new patient visit was billed (and paid) under her name/number.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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