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Printed Date: 9/22/2015
"New patient" means a patient who has not received any professional services, such as an E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous three years. For example, if a professional component of a previous procedure is billed in a three year time period (e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed), then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test (reading an X-ray or EKG, etc.) in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.
Reference: The CMS Medicare Claims Processing Manual, (PDF, 1.1 MB) Chapter 12, Section 30.6.7.
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Last Updated: 03/01/2021
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