Can I submit a subsequent hospital visit if my documentation does not support one of the three levels of an initial hospital visit?

Answer
Yes, subsequent hospital CPT codes (99232 and 99231) can be submitted in place of initial hospital CPT codes (99221-99223) if the minimum key component work and/or medical necessity requirements for initial care services are not met.

Resources

  • CMS IOM 100-04, Medicare Claims Processing Manual, Chapter 12 (PDF, 1.05 MB), Section 30.6.9.1. F
  • CMS MLN Matters Article MM7405 (PDF, 100 KB)

Contact Railroad Medicare

Email Railroad Medicare

Contact a specific Railroad Medicare department

Provider Contact Center: 888-355-9165

IVR: 877-288-7600

TTY: 877-715-6397

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

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

Anonymous

 

Click to Chat Now