Medical Care and Associated Services

Policy ID: NDRP-GC-018
Section: Medical Care and Associated Services
Effective Date: July 01, 2018
Last Reviewed: September 05, 2019

Description:

This policy provides direction on services identified as bundled into an evaluation and management (E/M) service. The services discussed in this policy are inherent components of an E/M service.

Policy:

Routine medical care may include itemized billing. Some services cannot be separately billed when an E/M is billed on the same day or within a designated timeframe from the medical visit. CPT Guidelines must be followed when separately reporting services that are components of an E/M service. When any of the below services are reported on the same day as an E/M service (or within the designated timeframe below), payment for the below services will be included in the allowance for the E/M service.

  • 96127 – Brief emotional/behavioral assessment may not be billed on the same day as an E/M service.
  • 99172 and 99173 – Visual function screening, automated or semi-automated may not be billed on the same day as an ophthalmological service or a non-preventive E/M service.

The above list is not an all-inclusive list of services not separately billable with an E/M service. Providers must refer to National Correct Coding Guidelines and the CPT and HCPCS Coding Guidelines.

Cross Reference:

CPT Guidelines