Tuesday, October 30, 2012

Medicaid update - Limit on office visit - General physician

General Physician Visit Exception

Beginning August 1, 2012, reimbursement for procedure codes 99201-99215 is limited to two per month for general services.  This affects the following provider types and specialties: provider types 25, 26, 29 and 30 with a specialty code of 009 (Family Practice), 011 (General Practice), 012 (Preventive Medicine), 018 (Internal Medicine), 045 (Public Health), 075 (Adult Primary Care), 077 (College Health Nurse), 080 (Family Nurse).
Exemption to this limit automatically applies to the following:
  • Recipients under the age of 21
  • A pregnancy-related diagnosis code associated with the visit
  • Visits provided in county health departments, federally qualified health clinics or rural health clinics
  • The rendering provider has another specialty on their enrollment file
Claims with documentation may be submitted for consideration to your local Medicaid area office to override the limit for the following diagnoses:
  • End-stage cirrhosis and ascites (requiring adjustments to diuretic medications and check of potassium levels)
  • Diabetes with complications of peripheral neuropathy resulting in infected foot ulcer (requires frequent visits for antibiotics, debridement)
  • Pneumonia and comorbidities (to monitor treatment response)
  • New onset of syncope (evaluation, review of studies and follow-up)
The Agency for Health Care Administration (Agency) may consider additional diagnoses to exempt from the limit.

Send your claims with documentation describing the medical necessity of the visit to your local Medicaid area office addressed with “Attention: Exceptional Claim Process.”  Contact information for the Medicaid area offices can be found at http://www.mymedicaid-florida.com/.
The Agency wishes to thank you for your continued care of our Medicaid recipients.  Your cooperation in this effort is appreciated.

1 comment:

  1. I am not that good when it comes to such issues on medical aspects. But I believe this has more to do with medical billing and coding.


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