E-Prescribing Developments and Considerations – Part IV

As previously discussed, there are three main requirements for earning a Medicare E-Prescribing bonus. During the prior blog we considered the first requirement, i.e., the use of a “qualified” E-prescribing system. Today, we will address the second of the three requirements.

In order to qualify for a Medicare bonus, at least 10% of a provider’s (or practice’s, as the case may be) aggregate Medicare reimbursement during the relevant year must come from claims identified by certain procedure codes. In particular, 10% of all the provider’s reimbursements must relate to procedures identified by the following codes:

  • New patient, Office: 99201, 99202, 99203, 99204, 99205
  • Established patient, Office: 99211, 99212, 99213, 99214, 99215
  • Office consults: 99241, 99242, 99243, 99244, 99245
  • Psychiatric Diagnostic/Therapeutic: 90801,90802, 90804, 90805, 90806, 90807, 90808, 90809
  • Health and Behavior Assessment: 96150, 96151, 96152
  • Opthamological New/Established Patient: 92002, 92004, 92012, 92014
  • Miscellaneous: G0101, G0108, G0109

We hope that this discussion has been helpful. Our next blog will focus on the third main requirement for earning a Medicare bonus for E-Prescribing.

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