Billing and Documentation

The 2023 CMS guidelines seem to have changed the definitions for the first critical care hour and first subsequent 30 mins, which in turn effects critical care reimbursement.  We are being told that CMS will not reimburse for the first 99292 until at least 104 minutes are billed.  (So if you docucument / bill 85 minutes, that will only count as a 99291.) Am wondering if anyone has information on this?  Are we misinterpreting the new guidelines? 

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Mary-Margaret Lewis, MD
Physician
PMA Health
Arlington VA
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Original Message:
Sent: 3/19/2023 12:55:00 PM
From: Mary-Margaret Lewis
Subject: CMS 2023 billing for 99292

The 2023 CMS guidelines seem to have changed the definitions for the first critical care hour and first subsequent 30 mins, which in turn effects critical care reimbursement.  We are being told that CMS will not reimburse for the first 99292 until at least 104 minutes are billed.  (So if you docucument / bill 85 minutes, that will only count as a 99291.) Am wondering if anyone has information on this?  Are we misinterpreting the new guidelines? 

------------------------------
Mary-Margaret Lewis, MD
Physician
PMA Health
Arlington VA
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