Patient Facing Encounter Codes

$79 / year

CMS defines a patient-facing encounter as an instance in which a MIPS (Merit-based Incentive Payment System) eligible clinician billed for services such as general office visits, outpatient visits, and procedure codes under the Medicare Physician Fee Schedule.

Complexity

The list of patient-facing encounter codes is used to determine the non-patient facing status of MIPS eligible clinicians. A non-patient facing MIPS eligible clinician is:

An individual MIPS eligible clinician that bills 100 or fewer patient-facing encounters (including Medicare telehealth services defined in section 1834(m) of the Act) during the non-patient facing determination period, and

A group provided that more than 75 percent of the clinicians billing under the group’s TIN meet the definition of a non-patient facing individual MIPS eligible clinician during the non-patient facing determination period.

The list of patient-facing encounter codes are categorized into three overarching groups of codes (Evaluation and Management Codes; Surgical and Procedural Codes, and Visit Codes). The utilization of Evaluation and Management Codes, Surgical and Procedural Codes, and Visit Codes accurately classifies MIPS eligible clinicians as non-patient facing and patient-facing.

Given the flexibility in program requirements for non-patient facing clinicians, the encounter codes are critical for CMS to identify MIPS eligible clinicians.

Date Created

2016-12-29

Last Modified

2018-01-23

Version

2018-01-23

Update Frequency

Irregular

Temporal Coverage

N/A

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare and Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

Office Visit Code, Evaluation and Management Codes, Encounter Codes, Surgical and Procedural Codes

Other Titles

Patient-facing Encounters Codes List, HCPCS Codes

Name Description Type Constraints
HCPCS_Or_CPT_CodesUnique HCPCS or CPT Codestring-
High_Level_CategoryHigh Level Category / Description of Codestring-
HCPCS_Or_CPT_CodesHigh_Level_Category
98925OMT
98926OMT
98927OMT
98928OMT
98929OMT
98940CMT
98941CMT
98942CMT
90951Dialysis
90952Dialysis