Billing Rules

Oct 1, 2005

We have a multispeciality group under one tax ID number. Can we bill for a new patient service if the patient has been seen by another specialist within the group?

Question: We have a multispeciality group under one tax ID number. Can we bill for a new patient service if the patient has been seen by another specialist within the group?

Answer: According to CPT, "A new patient is one who has not received any professional services from the physician OR another physician of the SAME specialty who belongs to the same group practice within the past three years."

So, yes, you may be able to count a patient as a new patient even if he has been to the group in the past three years, provided that his visit was to a physician in a different specialty.

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