How to Bill CPT Code 99211, can the nurse billed for cpt code 99211?

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How to Bill CPT Code 99211, can the nurse billed for cpt code 99211?

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Per CPT code 99211 is located under the evaluation and management (E/M) service.
The CPT manual defines code 99211 as an office or other outpatient visit “that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, five minutes are spent performing or supervising these services.”

On the other hand, the guidance issued by CMS Medicare on the proper use of 99211 notes that all Evaluation and Management E/M services, including 99211, are physician services. So udner Medicare guideline, only physicians and other specific non-physician practitioners (eg. nurse practitioners, clinical nurse specialists, physician assistants and certified nurse midwives) (“NPPs”) can bill for 99211 and any other E/M services which are medically necessary.

This CPT Code 99211 thus indicate a very limited service and, per its definition, “may not require the presence of a physician.” And it must be noted that CPT Code 99211 does not have key elements such as a history and physical examination. Like all evaluation and management E/M cpt codes, however, the service must still be provided face-to-face encounter by the staff rendering the service, and must identify the medical necessity.
Because medical necessity is required, vital signs and blood pressure checks may not be routinely performed at the time of another coded service in order to bill for a 99211 visit.

Can a nurse bill for it? if Medically Necessary, the Nurse service will be incidental to the Physician’s service. And thus, the ”incident-to” rule will apply.

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