New Patient Visits
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Defines Florida Blue's definition of a new patient, acceptable billing/coding for new patient E/M services, and reimbursement guidance for providers billing on CMS-1500 or equivalent forms across all lines of business.
HCPCS codes G0660-G0664 for Team Remote visits were added to the Billing and Coding section.
Telemedicine E/M service CPT codes 98000-98003 (audio-video) and 98008-98011 (audio-only) were added previously and are included in the policy.
Policy applies to billing on a CMS-1500 or equivalent claim form and defines 'same provider' as physicians and/or other health care professionals reporting under the same Federal Tax Identification number.
New Patient Coverage Criteria
New patient coverage criteria
Covered when ALL of the following are met:
New Patient E/M Codes and Time Thresholds
| 99202-99205 | Office or other outpatient new patient E/M visit codes (time and MDM thresholds apply) |
| 99381-99387 | Initial comprehensive preventive medicine new patient codes by age |
| G0660-G0664 | Team remote E/M new patient time-based HCPCS codes |
| 98000-98003 | Synchronous audio-video new patient E/M visit codes |
| 98008-98011 | Synchronous audio-only new patient E/M visit codes (time thresholds apply) |
| 92002-92004 | Ophthalmological new patient exam codes (intermediate and comprehensive) |
| S0610-S0620 | Selected new patient preventive/ophthalmological/gynecological HCPCS/S codes |
Billing Rules and Provider Requirements
Bill new patient services only when new‑patient definition is met
Bill new patient services only when the patient meets Florida Blue’s “New Patient” definition: the patient has not received any professional services from the physician or another physician and/or health care professional of the same group practice and same specialty within the past three years. If that definition is not met, report the appropriate established patient E/M code instead.
- “Professional services” include any E/M service or other face‑to‑face service (e.g., surgical procedure or global diagnostic service).
- Interpretation-only services (for example, reading an x‑ray or EKG) do not change new patient status.
- The policy applies to billing on a CMS‑1500 or equivalent claim form; “same provider” includes practitioners reporting under the same Federal Tax Identification number.
Key Definitions
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