Skip to Main Content
Issue Number - Name
0132-Evaluation and Management (E&M) Same Day as Admission to a Nursing Facility
Review Type
Automated
Claim Type
Physician/Non-Physician Practitioner
Region and State
RAC 1-4
All A/B MACs
Date Approved
2019-01-08

Description

CMS will not pay a physician for an emergency department visit or an office visit and a comprehensive nursing facility assessment on the same day. Bundle E/M visits on the same date provided in sites other than the nursing facility into the initial nursing facility care code when performed on the same date as the nursing facility admission by the same physician.

Affected Codes

CPT Codes 99201-99215, 99281–99285

Applicable Policy References

Social Security Act: Section 1833(e) 
CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.7, C
CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.11, D 
CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.13, A