ACP American College of Physicians - Internal Medicine - Doctors for Adults

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• Patient-Centered Medical Home
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  • Group Visits
  • Patient Education Resources
  • Patient Safety

Group Visit Billing Information

Because group visits are relatively unusual, no nationally accepted standard has yet emerged for billing them, and there is no special code for standard group visits. Acceptable billing thus varies both geographically and among different carriers. In cases where carriers have yet to adopt policies on group visit billing, the practice may be able to gain acceptance of its own proposed methodology - usually billing for each patient individually based on the services documented in the chart just as though the patient had been seen separately.

Private Insurers

It is our understanding that many private insurers allow physicians to bill for each visit provided to a patient in a group setting using the appropriate Current Procedural Terminology (CPT) evaluation and management (E/M) code for established patient office visits, CPT 99211-99215. However, PMC recommends that physicians inform each insurer in advance of their intent to begin furnishing group visits and how they plan to bill for them, thus giving the carrier an opportunity to communicate any concerns it may have or request an alternative billing arrangement.

Medicare

Before billing Medicare for group visits a physician should definitely contact the Medical Director for the Medicare carrier in that state to inquire how to bill for services provided to each Medicare beneficiary in a group setting. You can access the contact information for your Medicare Carrier Medical Director (CMDs) online by: entering your state in "Step 1"; selecting "carrier" as the type of organization in "Step 2"; and selecting "contractor medical director" as the type of contact in "Step 3". Clicking the "Search" button will then give you access to the contact information for the CMD for your state.

Page posted: 04/13/04

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