There has been some confusion about when a patient is new vs established. CPT’s definition is a bit different from some payor’s definition when it comes to working with APPs. UTMB follows the CPT definition as listed below.
A new patient is one who has not received any professional services from the physician or other qualified health care professional or another physician or other qualified health care professional (APP) of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.
An established patient is one who has received professional services from the physician or other qualified health care professional or another physician or other qualified health care professional (APP) of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.
When APPs are working with faculty, they are considered as working in the exact same specialty and subspecialty as the faculty.
Scenarios:
New Patient:
- Faculty or APP sees a patient for the first time today
- Patient has not been seen by another faculty or APP of exact same specialty and subspecialty within the UTMB group within the last three years.
Established Patient
- Faculty or APP sees a patient for the first time today
- Patient has been seen by faculty or APP of the exact same specialty and subspecialty within the UTMB group within the past three years.
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