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Issue Number - Name
0037 - Excessive Units of Hospital Services
Review Type
Automated
Claim Type
Professional Services (Physician/Non-physician Practitioner)
Region and State
RAC 1-4
All States
Date Approved
2017-02-23

Description

Initial Hospital Care codes (CPT codes 99221–99223) and Subsequent Hospital Care codes (CPT Codes 99231 99233) are "per diem" services and may be reported only once per day by the same physician(s) of the same specialty from the same group practice.

Affected Codes

  • CPT Codes 99221-99223 and 99231-99233

Applicable Policy References

  • Title XVIII of the Social Security Act (SSA), Section 1833 (e)
  • 42 Code of Federal Regulations §424.5(a)(6)
  • CMS Pub. 100-04, Medicare Claims Processing Manual,Chapter 12, 30.6.9-30.6.9.1 and Chapter 12, 30.6.9.2
  • American Medical Association (AMA), Current Procedure Terminology 2007 to 2017