Medical services are characterized by face – to – face services for the purposes of classifying new and established patients. 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 3 years. An established patient is one who has received professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past 3 years.
The CPT definitions do not explicitly address the question of cross referral to a subspecialist within a given group. For example, if a headache specialist, whose practice is exclusively limited to the care of headache patients, practices with a group of neurologists who are not headache specialists, is it possible for a patient, who may be referred to the headache subspecialist within the same group, to be considered a new patient. The answer is yes but it would be best if the headache subspecialist had a
separate tax identification number for their subspecialty. Since the question of subspecialty reporting within a given specialty is not precisely addressed in CPT definitions, this type of cross referral would be open to interpretation.