When is a patient considered “new” for professional billing purposes?

A new patient is one who has not received any professional services, such as an E&M service or other face -to face service (e.g., surgical procedure), from the physician or physician group practice (same physician specialty) within the previous three years.  For example, if a professional component of a previous procedure is billed in a three year period (e.g., a lab interpretation is billed and no E&M service or other face-to face service with the patient is performed), then this patient remains a "new" patient for the initial visit.

An interpretation of a diagnostic test, reading an X-ray or EKG, etc., in the absence of an E&M service or other face-to face with the patient, does not affect the designation of a new patient.