Continuing Care from Previous Patient (CCFPP) Fee Items 01205, 01206 and 01207

When more than one patient is seen on the same special call-out, the following rules apply:

  • When a physician is called out to attend more than one patient, the physician may bill non-operative continuing care surcharges (fee items 01205, 01206, 01207) for each half-hour of care provided as long as the criteria for those fees are met.

  • Non-operative continuing care surcharges are also applicable without the 30 minute time lapse and with timing continuing, to immediately subsequent patients seen on the same call-out as an emergency.

  • Non-operative continuing care surcharges do not apply to time spent standing by and are based on the amount of time providing care, regardless of the number of patients attended or services provided.

  • Notes:

    i) Claim must state start and end times.

    ii) Where timing is continuous submit an account for each patient, indicating "CCFPP" (continuing care from previous patient).

    iii) Not applicable to full or part-time emergency practitioners or to on site practitioners providing coverage in drop-in emergency clinics or hospital emergency rooms.

  • CCFPP must be noted on the first line of your note record for all claims where care is continuing from a previous patient.
    If your note record does not indicate "CCFPP" on the first line for these cases, the 30 minute refractory period will be deducted from your payment.
  • Timing is based on the total time spent providing continuous care, not the number of patients seen (e.g.: if three patients are seen in one half-hour period, the applicable non-operative continuing care surcharge may be charged only for the last patient seen in that half-hour period).

    For example: If the first patient is seen at 2020 hours, the 30 minute refractory period ends at 2050 hours. If multiple patients are seen between 2050 and 2120 hours, the full half-hour period should be billed for the PHN of the last patient seen during that time.

  Tip: Your note record must indicate "CCFPP" or the 30-minute refractory period will be deducted from your payment.

Example 1

Physician is called from home in the evening on an urgent basis to attend a patient (age 48) at the hospital. During the time spent with that patient, the physician is asked to see another patient (age 35) who also requires emergency care. Total time spent with the first patient is 15 minutes, and total time spent with the second patient is 20 minutes.

What to bill:
Patient Fee Item Start Time End Time Note
A 13200
A 01200 1845 1900
B 13200
Explanation:

No additional fee is payable under fee item 01205 because an additional 30 minutes or greater portion thereof has not been spent in addition to the original 30 minute refractory period for the total time spent with both patients.

Example 2

Physician is called from home on an urgent basis on a weekend to attend a patient (age 21) at the hospital. After assessment and treatment of that patient, the physician decides to assess three other patients who are already hospital inpatients. Total time spent with the patients is one hour: 30 minutes with the first patient and 10 minutes with each of the other three patients.

What to bill:
Patient Fee Item Start Time End Time Note
A 13200
A 01200 1015 1045
B 13008
C 13008
D 13008
Explanation:

The first patient was seen on an urgent basis. Although 30 additional minutes were spent with the other three patients, no additional charges may be made under fee item 01207 because these were non emergency services.

Example 3

Physician is called from home in the evening on an urgent basis to attend a patient (age 24) at the hospital. During the time spent with that patient, the physician is asked to see another patient (age 40) who also requires emergency care. Total time spent with the first patient is 30 minutes, and total time spent with the second patient is 25 minutes.

What to bill:
Patient Fee Item Start Time End Time Note
A 13200
A 01200 1815 1845
B 13200
B 01205 1845 1910 CCFPP
Explanation:

The total continuous time spent with both patients was 55 minutes. After the initial 30 minute refractory period had expired, 01205 was applicable because the remaining time spent with the patient was a major portion of an additional 30 minute period.

Disclaimer: MSP Tutor is intended to provide a guide for physicians and medical office assistants in billing claims to MSP. For definitive information on fee-for-service fee item codes and amounts, consult the current MSC Payment Schedule. If a discrepancy exists between the information contained in MSP Tutor and the MSC Payment Schedule, the information in the Payment Schedule will prevail.

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