Please define qualified health care professional as used by CPT code 96119 . ...
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Article Overview
This short Find-A-Code article discusses how CPT uses the term qualified health care professional in a general sense, with attention to licensure, scope of practice, and payer policy considerations. It is aimed at coders, billers, compliance staff, and clinicians who need a non-proprietary understanding of CPT reporting context for professional services.
Why This Topic Matters
Understanding how CPT frames qualified health care professional helps reduce reporting errors and supports more accurate compliance review when services may be performed by different types of practitioners. The article is relevant when determining whether a provider meets general reporting expectations under CPT and when external rules such as state law or payer policy may apply.
What You Will Learn
- How CPT generally frames the term qualified health care professional
- Why state licensure matters in reporting CPT services
- How payer policies can affect reporting and reimbursement for non-physician services
- Where to look for authority on whether a practitioner may perform a service
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Physicians
- Non-physician health care professionals
- Practice administrators
Codes Discussed
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