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Issue Number - Name
0070 - Critical Care billed on the same day as Emergency Room
Review Type
Automated
Claim Type
Physician/Non-Physician Practitioner
Region and State
RAC 1-4
All States
Date Approved
2017-10-04

Description

Hospital emergency department services are not payable for the same calendar date as critical care services when provided by the same physician or physician group with the same specialty to the same patient.

Affected Code(s)

  • 99281, 99282, 99283, 99284, 99285

Applicable Policy References

  • Title XVIII of the Social Security Act, Section 1833 (e)
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.12 (H) & (I)