Physicians in Same Group, Same Specialty: Bill Medicare as One

Physicians in the same group practice who are in the same specialty must bill Medicare as though they were a single physician. If more than one  face-to-face evaluation and management (E&M) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one E&M service may be reported unless the E&M services are for unrelated problems.

Instead of billing Medicare separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level. When the duration of the direct face-to-face contact between the physician and the patient exceeds the typical time of the visit code billed, use the prolonged services codes (99354-99357).

Physicians who are in the same group practice but in different specialties may bill Medicare without regard to their membership in the same group.


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