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Thread: New versus Est.

  1. #1

    Default New versus Est.

    AAPC: Back to School
    I have a provider who saw a patient for a Workman's Comp injury and billed a New patient visit. The patient came back a month later but now has an injury that is not Workman's Comp related and the provider is billing a New patient visit to their Medicare. Is this correct? I was told that it is different when the initial visit was work related and the second visit is not. I can not find anything to prove this. Please help and as always Thanks for the help.

  2. #2
    Join Date
    Apr 2007
    Chattanooga, TN


    It has always been my understanding that there are no exceptions to the new patient requirements for Medicare billing, if the patient has been seen by a provider within that practice within the past 3 years they are not new. I haven't found anything stating otherwise. If you do find something different please post it because that would be great info to have.

  3. #3


    That's correct. If the patient was seen in the office in the past 3 years, a new patient 99201-99205 can not be billed.

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