Subsection 351-5-2-02 - EVALUATION AND MANAGEMENT GUIDELINES1.Definition of New PatientA. A new patient is one who has not received any professional services from the health care provider (or another health care provider of the exact same specialty and subspecialty who belongs to the same group practice) within the past three years, orB. A new patient is one who is being evaluated for a new injury/illness to determine work relatedness/causality, orC. A new patient is one who is being seen for a new episode of care for an existing injury/illness.2.Payments for New Patient VisitsOnly one new patient visit is reimbursable to a health care provider (or another health care provider of the exact same specialty and subspecialty who belongs to the same group practice) for the same patient relating to the same episode of care.
3. For purposes of this section, "episode of care" includes all the professional services provided by the health care provider (or another health care provider of the exact same specialty and subspecialty who belongs to the same group practice) for the same patient for the same injury/illness from date of initial examination to date of discharge from care. C.M.R. 90, 351, ch. 5, § 351-5-2, subsec. 351-5-2-02