Billing for Family Members Seen During the Same Visit

When more than one person in a family attends a physician's office at the same time, a visit fee is not always billable for each family member.

Visits that can be billed for more than one family member during the same visit

When each family member is receiving medical diagnosis and/or treatment during one visit, it is appropriate to bill a service for each person.

For example, if a parent and child are both seen for diagnosis and treatment of upper respiratory infection (URI) during the same visit, a visit fee may be billed for each person.

Visits that cannot be billed for more than one family member during the same visit

When one family member has a medical problem, it is almost always inappropriate to bill for discussion with other family members/persons about that patient's condition.

For example, if a child is seen for upper respiratory infection (URI) and the physician takes the history from the parent and gives treatment instructions to the parent, a visit fee may be billed only for the child.

Tips: Standard medical care of a patient may require that the physician communicate with a parent, spouse, or caregiver of the patient. Routine communication is considered to be included in the initial visit fee for the patient, even if the communication takes place on a different day.
For more information please refer to Preamble A. 2. of the MSC Payment Schedule.
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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.