100% Pre-Payment Review of CPT Code 99214

 
Medicare has initiated a special targeted pre-payment review of all CPT code 99214 services.  After conducting a review of documentation for this level outpatient office visit for an established patient, Medicare has concluded that the documentation often failed to meet the CPT documentation requirements for this service.  Psychiatrists may be using Code 99214 in combination with an add-on psychotherapy visit such as 90833, 90836, or 90838.  NYSPA has prepared a guideline for minimum documentation requirements for Code 99214.  Members can click here to read and download the NYSPA guidelines. Failure to record the minimum required documentation for a Code 99214 can result in disallowance or reduction to a lower level E/M code and recovery of overpayments.

Under pre-payment review, your claim will be pended until documentation is reviewed. If you do not respond to the records request, the claim will be denied.