Medicare patient type · CASE 4 OF 5
New to you, established to the practice
Apply the Medicare patient-type rule to a return visit within the same group and specialty.
Educational beta. Independent clinician review has not yet been completed. No CME credit is offered.
Sources checkedTHE FICTIONAL CASE
You meet a Medicare patient for the first time. Eighteen months earlier, a physician in your group with the same specialty and subspecialty provided this patient an office visit.
Read the answer and explanation without the quiz
Established
The patient is established. Under the Medicare rule, this prior same-specialty group visit falls within three years. Being new to the individual physician does not by itself make the patient new to the practice.
Check the source
- CMS: Evaluation and Management Services ↗
May 2026, page 23, Patient Type
The source check supports the rule used in this fictional exercise. It is not independent professional certification. Actual claims require the complete documentation and current payer requirements.