Face-to-Face Requirement for Evaluation & Management (E&M) Services

Face-to-Face Requirement for Evaluation & Management (E&M) Services

by abilling, May 10, 2013

WPS Medicare recently (end of March) released the below information through their WPS Medicare ENEWS.  We would like to bring this to your attention for review. Although this was submitted by WPS Medicare, the face-to-face requirement for E&M Services applies to all Medicare Carriers and is not specific to WPS.

“….A face-to-face encounter with the patient must occur and be documented in the medical record in order to bill an E/M service. Upon medical review, Medicare will reduce or deny these services if there is no documentation for a face-to-face service.

We recommend physician/provider practices perform periodic self audits to ascertain if any problem areas exist which may warrant further education or corrective actions. For more guidance on proper billing and documentation of E/M services, visit our Evaluation and Management web page at http://www.wpsmedicare.com/j5macpartb/resources/provider_types/evalandmngmnt.shtml



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Reasonable attempts have been made to be accurate.  However, medical billing, collections, coding and compliance are part science, part art, and even experts sometimes differ.  Neither Anesthesia Billing, Inc., the editors, publisher, contributors, or consultants warrant or guarantee the information contained will be applicable or appropriate in all situations.  For information specific to your practice, consult a qualified professional.

The information included in this publication is provided, among other things, to alert you to legal developments and should not be considered legal advice.  Specific questions about how this information affects your particular situation should be addressed to your attorney.

Editor:  Philip Blann (pblann@anesthesiabilling.com).

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