"Medical necessity of a service is the overarching criterion for payment in addition to the
individual requirements of a CPT code. It would not be medically necessary or
appropriate to bill a higher level of evaluation and management service when a lower
level of service is warranted. The volume of documentation should not be the primary
influence upon which a specific level of service is billed. Documentation should support
the level of service reported. The service should be documented during, or as soon as
practicable after it is provided in order to maintain an accurate medical record."
https://www.cms.gov/transmittals/downloads/r178cp.pdf (Page 2)
Also, Trailblazer Medicare (our local carrier) has this article:
If you live in another part of the country, I'd be willing to bet my next paycheck that your LCD's will have a similar stance, but you should always check. I searched "Trailblazer medicare E/M level medical necessity" on Yahoo and that page was the first one to pop up. Hope that's what you needed!
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