The concept of new and established patients has been part of the Current Procedural Terminology (CPT) nomenclature for quite some time. However, there still seems to be a lot of confusion on how to apply each definition in different scenarios. This also is complicated by the fact that CPT recently altered the definition of each term.

According to CPT, a new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.

An established patient is one who has received professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.

Solely for the purposes of distinguishing between...

You do not currently have access to this content.