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April 17, 2014 - Revised 04.15.16

Revised Concurrent Care – Evaluation & Management (E/M) Service: Similar Services from Multiple Providers and Non Physician Practitioners Within the Same Group

Concurrent care exists when services are performed by more than one physician/nonphysician practitioner (NPP) in the same group practice on the same date of service for the same patient. Most commonly, concurrent care occurs when the same patient is seen by multiple providers of the same or similar specialties for the same diagnosis. Reasonable and necessary services rendered with concurrent care may be covered if the medical record shows each practitioner supplied knowledge or services the attending physician could not provide. Only one E/M encounter may be reported by practitioners in the same specialty, same group practice on the same DOS unless the services are for unrelated problems. Otherwise, physicians and NPPs must bill as though the services were provided by a single physician.

If the claim is denied it can be appealed by submitting signed documentation showing the services provided were in accordance with the above guidelines. And while Medicare does not designate sub-specialties for all provider types, we strongly recommend that you identify each practitioner's sub-specialty to further demonstrate why it was medically necessary for multiple providers from the same practice to provide E/M services on the same date.

Denials may be prevented by including the following information with the initial claim submission:

  • Electronic claims: include the billing provider's sub-specialty designation (both the numeric AND narrative sub-specialty description are required) in either NTE 2300 Loop or Line NTE in the 2400 Loop
  • Paper claims: include the billing provider's sub-specialty designation in Item 19
  • The claim line diagnoses listed should be specific to the reason for the billed visits

Reference:

REVIEWED 12.15.22

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