Effective 12/01/2020-Oxford Commercial Plan has revised their E/M code reimbursement policy for Non Physician providers.
The policy expanded the Non-Physician Providers List that are not allowed to report E/M codes. Please see the partial list below:
Definitions: Physician- MD or DO
Guidelines as per Oxford: Only Physicians and other qualified healthcare professionals are allowed to bill E/M codes. These other qualified healthcare professionals include: “nurse practitioners (NP), clinical nurse specialists (CNS), certified nurse midwives (CNM) and physician assistants (PA), none of which are considered non physician health care professionals for purposes of this policy”.
Oxford will not reimburse E/M services (CPT codes 99091, 99201-99499) when reported by nonphysician health care professionals reporting under their own individual or group tax identification number (TIN).
According to the Oxford Policy- non physicians should use HCPCS ot/and CPT codes that correspond to the services that were performed (the most comprehensive CPT code that describes the services performed- as written by CMS).
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