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Case 13.3 Using Insurance Terms Read this information from a Medicare carrier and answer the questions...

Case 13.3 Using Insurance Terms

Read this information from a Medicare carrier and answer the questions that follow.

E&M services rendered in a private residence are correctly billed with CPT codes 99341–99345 (new patients) and CPT codes 99347–99350 (established patients), home services. These CPT codes are payable only in home settings, that is, place of service 12.

National Government Services has seen many instances of providers billing outpatient/office codes in home set¬tings. Home visits should not be reported with E&M codes 99201–99215, which represent office and outpatient services.

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Home visit CPT codes should be reported from 99341-99350. E/M service in a private residence and can not be used if the patient resides in a shared living facility. The home visit includes average time for coordinating of care that is face to face visit patient and provider spend the times. It includes when patient residing in their own residence and they qualify for medical necessity to meet the ongoing need when they have the health issues. that can be a new patient or establishes a patient.

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