Billing and Payments. We will review Medicare Part B payments for PMD to determine whether the Medicare requirements for a face-to-face examination were met. Context—Medicare requires that the treating physician, when prescribing a PMD, conduct a face-to-face examination to determine the medical necessity of the PMD and write a prescription for the PMD. (42 CFR § 410.38(c)(2).) To receive compensation for conducting the face-to-face examination, the prescribing physician can bill for an evaluation and management (E/M) service and has the option of billing Medicare for an add- on payment for the sole purpose of documenting the need for the PMD. Prior OIG work found that when the prescribing physician did not bill the code for the add-on payment in addition to the evaluation and management (E/M) code, the resulting PMD claim was likely to be
unallowable. (OAS; W-00-14-35460; expected issue date: FY 2014; work in progress)