Evaluation and Management Services

Selection of Level Of Evaluation and Management Service

Physicians select the code for the service based upon the content of the service. The duration of the visit is an ancillary factor and does not control the level of the service to be billed unless more than 50 percent of the face-to-face time (for non-inpatient services) or more than 50 percent of the floor time (for inpatient services) is spent providing counseling or coordination of care.

Any physician or NPP authorized to bill Medicare services will be paid by the carrier or Part A/B Medicare Administrative Contractor (A/B MAC) at the appropriate Medicare Physician Fee Schedule (MPFS) amount based on the rendering National Provider Identifier (NPI). Incident to Medicare Part B payment policy is applicable for office visits when the requirements for incident to are met.