How will Medicare pay for a consultation service requested by another physician in the same group practice?
The policy states that Medicare may pay for an inpatient hospital visit or an office/outpatient visit if one physician in a group practice requests an E/M service from another physician in the same group practice when the consulting physician has expertise in a specific medical area beyond the requesting professional’s knowledge. The consulting physician must report the appropriate E/M code based on the level of service provided. The policy does not clarify whether or not a patient referred from a physician within the same group practice with a separate specialty designation (e.g., Internists) will enable the consulting physician to bill for a new patient visit vs. an established patient visit. For further clarification on what Medicare constitutes as a new or established patient, the Heart Rhythm Society recommends that members contact their local Medicare MAC, FI or carrier.
Related Questions
- If the patient is readmitted and the same physician is requested again for consultation, can we bill another initial inpatient hospital service code?
- Why doesn Medicare pay for a radiology service billed by a physician with the place of service in-hospital?
- If Medicare denies a consultation service, what is the denial code? Should the physician bill the patient?
