Physician-Patient Interaction Codes
In addition to billing Time Codes physicians can also bill for physician-patient interactions included in the LFP Payment Model using a Patient Interaction Code.
Fee-For-Service codes, such as tray fees and diagnostic tests, are not payable in addition to Patient Interaction Codes in relation to services included in the LFP Payment Model.
Patient Interaction Codes are subject to the following limits:
(a) Maximum Interactions Paid Daily – The maximum number of Patient Interaction Codes payable in a single calendar day is 50. This maximum applies to all Patient Interaction Codes, except 98022. This maximum does not apply to services provided in communities that were receiving NIA premiums as of December 15, 2002.
(b) Maximum Payment for Services to Patients not on Panel – A physician cannot claim more than 30% of their Patient Interaction Codes for Non-Panel Services in one calendar year. The physician is not entitled to payments in excess of the 30% limit. If a physician exceeds this 30% limit, they cannot bill Fee-for-Service for additional Clinic-based Services.
For the purposes of section 16(b), the terms "Patient Interaction Codes" and "Clinic-based Services" exclude Maternity Services. Claims for Patient Interaction Codes that exceed typical numbers by peer family physicians are more likely to result in a review and/or audit.
How to Bill Patient Interaction Codes :
The following fields are required for each Patient Interaction Code:
• MSP Payee Number
• Practitioner Number
• Patient Personal Health Number (PHN)
• Patient Name
• Patient Date of Birth
• Date of service
• Interaction code (fee item)
• ICD-9 Diagnostic Codes (1 code mandatory, 3 maximum)
• Location Code
• Facility Number
• Referring/Referred practitioner # (if the Physician is referring the patient to or receiving a referral from another practitioner).
The “Patient Interaction Codes”, as explained in detail below, are the following:
• 98031 LFP In-person Interaction in a Clinic
• 98032 LFP Virtual Interaction by Phone or Video
• 98022 LFP Minor Procedure or Diagnostic Test Provided with an In-person Interaction
• 98021 LFP In-Person Interaction with a Standard Procedure
• 98020 LFP In-Person Interaction with an Advanced Procedure
• 98033 LFP In-person Interaction in the Patient’s Home
• 98030 LFP Consultation
• 98034 LFP In-person or Video Group Interaction
You can review the LFP Payment Schedule for more information on these codes.
Guide for billing Time Codes