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April 24, 2025

Billing Instructions for Concurrent Care – E&M Service: Similar Services from Multiple Physicians & NPPs Within the Same Group

Concurrent care exists when services are performed by more than one physician or non-physician practitioner (NPP) in the same group practice on the same date of service for the same patient. Most commonly, concurrent care occurs when the same patient is seen by multiple providers of the same or similar specialties for the same diagnosis. Reasonable and necessary services rendered with concurrent care may be covered if the medical record shows each practitioner supplied knowledge or services the attending physician could not provide.

Providers can have claims considered for payment upon submission and avoid unnecessary appeals for concurrent care evaluation and management (E&M) services by taking the following actions:

  • Electronic claims: Include the rendering physician's sub-specialty designation, if applicable (both the numeric AND narrative sub-specialty description are required) in either NTE 2300 Loop or Line NTE 2400 Loop.
  • Electronic claims: Include the NPP specialty they’re representing (both the numeric AND narrative specialty description are required) in either NTE 2300 Loop or Line NTE 2400 Loop.
  • Paper claims: Include the rendering physician’s sub-specialty designation or the NPP specialty they’re representing in Item 19.
  • The claim line diagnoses listed should be specific to the reason for the billed visits.

Note: In practices where NPPs “wear multiple specialty hats”, it’s critical the claim loops are correctly identified and completed for the specialty type of service rendered addressed in each visit. Only one E&M encounter may be reported by practitioners in the same specialty, same group practice on the same date of service unless the services are for unrelated problems. Otherwise, physicians and NPPs must bill as though the services were provided by a single physician.

References:

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