• Quick Reference Fact Sheet

    Important Facts :

    CMS expects that the patient’s medical records will reflect the need for the item ordered. The patient’s medical records include:

    • Physician’s office records
    • Hospital records
    • Nursing home records
    • Home health agency records
    •  Records from other healthcare professionals
    • Test results

    Other stipulations of the rule include:

    • A prescription is not considered a part of the medical record.
    • Supplier-produced records, even if signed by the ordering physician, and attestation letters are not considered by Medicare as part of the medical record.
    • Templates and forms, including CMNs, are subject to corroboration with infor mation documented in the patient’s medical record.
    • Only a physician can document that the face-to-face encounter occurred
    • Signature and date stamps are not allowed
    • Multiple items can be supported by a single face-to-face encounter, so long as each item’s medical necessity is documented in the patient’s medical record.

    Physician Compensation

    CMS has established a G-Code (G0454) to compensate physicians who document that a Physician’s Assistant, Nurse Practitioner, or Clinical Nurse Specialist performed the face-to-face encounter. This G-Code does not apply when a physician bills an evaluation and management code when the physician performs the face-to-face encounter himself/herself. The G-Codes may only be used when the physician documents a face-to-face encounter that is performed by a PA, NP or CNS.

    If multiple orders for covered items originate from one face-to-face encounter, the physician is only eligible for the G-Code payment once.