How does the tax ID number impact the new vs established rule? Carriers are denying new patient services for the various specialties within the medical center.

By CPT definition, a new patient is “one who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.”

CMS guidance states, “For purposes of billing for E/M [evaluation and management] services, patients are identified as either new or established, depending on previous encounters with the provider. A new patient is defined as an individual who has not received any professional services from the physician/non-physician practitioner (NPP) or another physician of the same specialty who belongs to the same group practice within the previous three years.”