New Patient vs Established Patient Visit Claim Denials

Is your facility receiving denials on new patient Evaluation and Management (E/M) CPT codes? Could it be a result of a new patient vs established patient billing error?

Visit the New Patient vs Established Patient Visit webpage for new and established patient information; claim examples; resources; and access the "New Patient vs Established Patient Visit Decision Tree" which will help determine whether a patient is new or established.

If the denial received is because of a clerical error, a Reopening may be requested. If your facility would like to submit a Redetermination request(s), submit it via the Noridian Medicare Portal (NMP). For those providers who do not yet use NMP, please view registration and user/administrator details on the NMP webpage.

Last Updated Jan 31, 2019