Detailed Written Orders and Face-to-Face Encounters

Posted June 07, 2013

Effective Date: July 01, 2013

Implementation Date: July 01, 2013

As a condition for payment, section 6407 of the Affordable Care Act requires a physician to document that the physician, physician assistant (PA), nurse practitioner (NP) or clinical nurse specialist (CNS) has had a face-to-face encounter examination with a beneficiary in the six (6) months prior to the written order for certain items of Durable Medical Equipment (DME). This section does not apply to Power Mobility Devices (PMDs) as these items are covered under a separate requirement.

Physicians will be provided an additional payment, using G0454, for signing/co-signing the face-to-face encounter of the PA/NP/CNS. The physician should not bill the G-code when he/she does the face-to-face encounter. NOTE: The G-code may only be paid to the physician one time per beneficiary per encounter, regardless of the number of covered items documented in the face-to-face encounter.

Refer to Change Request 8304 for additional information:


Last Updated Dec 19 , 2019