- Patient-facing Encounters Codes List
- HCPCS Codes
- 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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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
John Snow Labs; Centers for Medicare and Medicaid Services;
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Office Visit Code, Evaluation and Management Codes, Encounter Codes, Surgical and Procedural Codes
Patient-facing Encounters Codes List, HCPCS Codes
|HCPCS_Or_CPT_Codes||Unique HCPCS or CPT Code||string||-|
|High_Level_Category||High Level Category / Description of Code||string||-|
|HCPCS Or CPT Codes||High Level Category|