Must a problem be new to the patient or new to the provider in order for it to be considered a "new problem" when scoring diagnosis/management options for an evaluation and management (E/M) service?

In most instances, a new problem is one that is new to the provider and being addressed at that visit. There are two exceptions to this general rule:

  • The initial visit of an established beneficiary in a single specialty group practice setting with a new provider
  • A visit by an "on call" or covering provider. In these instances, the established problems are treated as if the beneficiary was seen by the unavailable provider.



Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC


National Supplier Clearinghouse MAC


RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries



Click to Chat Now