Others titles

  • Patient-facing Encounters Codes List
  • HCPCS Codes

Keywords

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

Patient Facing Encounter Codes

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.

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Description

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.

About this Dataset

Data Info

Date Created

2016-12-29

Last Modified

2020-01-15

Version

2020-01-15

Update Frequency

Irregular

Temporal Coverage

N/A

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare and Medicaid Services;

Source License URL

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

Data Fields

Name Description Type Constraints
HCPCS_Or_CPT_CodesUnique HCPCS or CPT Codestring-
High_Level_CategoryHigh Level Category / Description of Codestring-

Data Preview

HCPCS Or CPT CodesHigh Level Category
10004Surgery Codes
10005Surgery Codes
10006Surgery Codes
10007Surgery Codes
10008Surgery Codes
10009Surgery Codes
10010Surgery Codes
10011Surgery Codes
10012Surgery Codes
10030Surgery Codes