Billing: CMS Transmittal Clarifies Proper E/M Claims Filing

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article covers a CMS clarification affecting office evaluation and management billing, with emphasis on how practices determine whether a patient is considered new for coding purposes. It is aimed at coders, billers, compliance staff, and physician practices that submit Medicare-related E/M claims. The discussion focuses on CMS guidance, same-practice considerations, specialty-related distinctions, and the impact on claim filing and correction processes.

Why This Topic Matters

Correctly identifying new-patient status affects E/M claim selection and helps practices avoid filing errors and resubmissions.

What You Will Learn

  • How CMS clarified the definition of a new patient for office E/M billing
  • Why face-to-face services matter in determining patient status
  • How same-practice and same-specialty considerations affect claim filing
  • What general situations may require claim correction or resubmission

Who Should Read This

  • Medical coders
  • Billing staff
  • Compliance professionals
  • Physician practice administrators
  • Medicare claims processors

Codes Discussed

  • CPT: 99202

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