Medicare calls a patient new after three years without a visit
Under Medicare's rule, visits from other specialties in your group don't count, and neither does a test interpretation with no face-to-face service.
Co-founder, JotPsych
Your colleague saw a patient last year, and the patient now books an intake with you. Check three years of your group's visits before you pick a new patient code.
From section 30.6.7.A of Medicare's claims manual, revision issued July 24, 2025. A patient your group saw in your specialty inside that time is established, even at an intake.
Who counts as new
Medicare's claims manual treats same-specialty physicians in one group as one physician, so a visit with any of them counts. Physicians in other specialties bill as if they weren't in your group, and their visits don't count toward your three years.
The past service can be an evaluation and management visit or any other face-to-face service. Your same-specialty colleague's medication visit last year makes the patient established. Your own past visits count too, whether you're a physician or a nurse practitioner, per Medicare's office visit guide.
| Service in the last three years | Patient is | Code family |
|---|---|---|
| None from your group in your specialty | New | 99202 to 99205 |
| Face-to-face visit with you | Established | 99212 to 99215 |
| Face-to-face visit with a same-specialty physician in your group | Established | 99212 to 99215 |
| Test interpretation with no face-to-face service | Still new | 99202 to 99205 |
From sections 30.6.5 and 30.6.7.A of Medicare's claims manual, chapter 12. One face-to-face service from your group in your specialty makes the patient established.
What to do before an intake
- Open the patient's visit history before you book. Look for any face-to-face visit in the three years before the intake date, and search your old chart system too if your group switched systems.
- Check each past clinician's Medicare specialty. Visits from your group in your specialty count. Visits from your group's other specialties don't.
- Pick 99212 to 99215 when you find a visit. Found none? Bill 99202 to 99205. Your medical decision making or total time picks the level in either family.
- Skip test interpretations. Interpreting a test, such as an electrocardiogram (EKG), with no face-to-face service doesn't make your patient established.
Medicare's rule doesn't say whether a nurse practitioner and a psychiatrist share a specialty, so ask your Medicare contractor how it lists each prescriber before you bill the intake.
JotPsych's Encounters list shows each past visit's date, type, and provider, imported visits included.
Book 15 minutes- Centers for Medicare & Medicaid Services, Medicare Claims Processing Manual, chapter 12, revision 13316, issued July 24, 2025: sections 30.6.5 (physicians in a group practice) and 30.6.7.A (new and established patients). Read October 5, 2026.
- Centers for Medicare & Medicaid Services, MLN006764, Evaluation and Management Services, May 2026: the new patient definition. Read October 5, 2026.