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Issue Number - Name
0042- Office Visits Billed for Hospital Inpatients
Review Type
Automated
Claim Type
Professional Services (Physician/Non-Physician Practitioner)
Region and State
RAC 1-4
All States
Date Approved
2017-03-09

Description

If evaluation and management services are being rendered to patients admitted to an inpatient hospital setting, then CPT Codes 99221-99223, 99231-99233 and 99238-99239 are to be used. CPT codes 99201-99215 are to be used for evaluation and management services provided in the physician's office, in an outpatient or other ambulatory facility.

Affected Codes

  • CPT Codes 99201-99215

Applicable Policy References

  • Social Security Act, Section 1833 (e)
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, 30.6, 30.6.9.1 and 30.6.10