What is a primary care exception?

What is a primary care exception?

Under the “primary care exception,” a medical resident may perform (and bill for) limited, specific evaluation and management services without the presence of a teaching physician.

What modifier is used to indicate to CMS that a service was provided in part by a resident physician participating in a GME program?

the GC modifier
Claims must include the GC modifier, “This service has been performed in part by a resident under the direction of a teaching physician,” for each service, unless the service is furnished under the primary care exception.

What is Gc modifier used for?

A GC Modifier is a modifier added to a CPT code for service(s) performed in part by a resident under the direction of a teaching physician (TP). When should the GC modifier be used? A GC Modifier is used when a resident, under the direction of a teaching physician, is involved in the management and care of a patient.

What does a GE modifier mean?

The GE modifier indicates that “service is rendered in a Primary Care Exception Site”. There are E&M services that a Resident can perform without the presence of a Teaching Physician under the Primary Care Exception.

Do you use a GC modifier for a fellow?

Because a fellow is still in the learning stages even though he is post-graduate, the GC would apply in this situation.

How does modifier GC affect reimbursement?

GC modifier has no impact on payment unless it is discovered on appeal that the teaching physician failed to document and electronically sign their attestation note. If you have a teaching physician supervising a resident, the GC modifier must be appended to that service.

Is the GC modifier only for Medicare?

Modifiers GC and GE are used to identify the involvement of a resident in the care of the patient. These modifiers should be used on Medicare and Medicaid patients whenever a resident is involved in the care provided.

What is an 80 modifier?

CPT Modifier 80 represents assistant at surgery by another physician. This assistant at surgery is providing full assistance to the primary surgeon. This modifier is not intended for use by non-physicians assisting at surgery (e.g. Nurse Practitioners or Physician Assistants).

What are GC and GE modifiers?

Modifiers GC and GE are used to identify the involvement of a resident in the care of the patient. These modifiers should be used on Medicare and Medicaid patients whenever a resident is involved in the care provided. the resident during the key portions of service OR personally performs key portions of service.

When can modifier 80 be used?

Definitions. CPT Modifier 80 represents assistant at surgery by another physician. This assistant at surgery is providing full assistance to the primary surgeon. This modifier is not intended for use by non-physicians assisting at surgery (e.g. Nurse Practitioners or Physician Assistants).

Can the 80 and as modifier be billed together?

Modifier AS is billed to indicate that a PA, NP or CNS served as the assistant at surgery. Modifier 80, 81 or 82 must also be billed when modifier AS is billed.

Is GC modifier only for e m?

only used with E/M. Also, an attestation must be documented in order to bill it.

Does Medicare want the 80 or as modifier?

Medicare does not recognize a registered nurse first assistant (RNFA) as a qualified Medicare provider. To report services of an assistant surgeon, the following surgical modifiers should be appended: 80 — Assistant Surgeon: This modifier pertains to physician’s services only.

What is the difference between modifier as and 80?

That is a medicare link but the definition of the AS and 80 modifiers in HCPCS and CPT seem clear enough. The 80 by itself indicates another MD or DO assisted, when you add the AS that clarifies that it was a PA, NP, or CNS.