Frequently Asked Questions
Who is classified as a "practitioner"?
CMS defines a practitioner as Physicians and NPP's (including those working under supervision).
What is a group?
CMS defines a "group" as practices who share the following between two or more practitioners (not necessarily at the same address):
- Business or financial operations
- Clinical facilities
- Records or Personnel
Are other practitioners allowed to report data or can only those in the 9 listed states report?
Providers in states others than those required to report on post-operative visits are not restricted from reporting.
Can post-operative visits be reported on other procedures besides those that have been identified?
Providers are not limited to only reporting for procedures that have been specified.
What if I or another practitioner within my TIN provide post-operative services twice in one day?
If furnishing multiple post-operative visits to the same patient on the same day, 99204 should only be reported once.
Can post-operative visits be reported from all sites of service?
Yes, visits can occur in all sites of service including (but not limited to) ICU, bedside/hospital inpatient, Outpatient Unit and SNFs.
Will there be additional data collection opportunities?
In addition to the claims-based data collection, CMS also finalized a policy to conduct a survey of practitioners to gain information on post-operative activities to supplement the claims-based data collection described above. CMS has not finalized the design of the survey instrument, but intends to begin surveying in mid-2017. This survey could impact physicians in all states, not just the nine states selected for claims-based data reporting. CMS has also indicated that the agency plans to collect global code data from accountable care organizations (ACOs), but has not described how it plans to collect those data or when the ACO data collection will start.