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Podiatrists and Optometrists Billing for Nursing Facility Assessments
Published Online: 09/27/2004
Podiatrists and optometrists cannot be reimbursed for comprehensive nursing facility assessment CPT codes 99301-99303. These codes require an evaluation and management of a new or established patient. According to the Centers for Medicare & Medicaid
Services (CMS), only a doctor of medicine or osteopathy legally authorized to practice medicine or surgery in the state may serve as a physician as described in regulation 42 CFR 483.40 (b)(1). This CFR regulation requires the physician to review
the nursing facility resident’s total program of care, which includes areas of assessment which are outside the scope of a podiatrist’s or optometrist’s practice. The nursing facility resident’s attending or admitting physician must perform a full
assessment. Podiatrists or optometrists may bill subsequent nursing facility care CPT codes 99311-99313 which include new or established patients. (Refer to the CPT 2000 for a full description of the CPT codes in this article.)
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42 CFR 483.40 (b1) |
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CIM Section 15501; 15509.1; & 15510 |
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CR 3096 |
Instead of billing the 99301-99303 codes podiatrist and optometrist may bill a consultation visit, when the primary care physician has ordered podiatry or optometry services, for the initial visit on a patient. The procedure codes for these
consultation visits are 99251 – 99255. Please note that the documentation must meet the criteria in the CPT4 (Current Procedural Terminology) and if records are requested a signed order, for the consultation from the attending physician must, be submitted
with the documentation.
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