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  <FDSYS>
    <CFRTITLE>42</CFRTITLE>
    <CFRTITLETEXT>Public Health</CFRTITLETEXT>
    <VOL>2</VOL>
    <DATE>2005-10-01</DATE>
    <ORIGINALDATE>2005-10-01</ORIGINALDATE>
    <COVERONLY>false</COVERONLY>
    <TITLE>What constitutes a visit.</TITLE>
    <GRANULENUM>405.2463</GRANULENUM>
    <HEADING>Section 405.2463</HEADING>
    <ANCESTORS>
      <PARENT HEADING="Title 42" SEQ="5">Public Health</PARENT>
      <PARENT HEADING="CHAPTER IV" SEQ="4">CENTERS FOR MEDICARE&amp; MEDICAID SERVICES,DEPARTMENT OF HEALTH ANDHUMAN SERVICES</PARENT>
      <PARENT HEADING="SUBCHAPTER B" SEQ="3">MEDICARE PROGRAM</PARENT>
      <PARENT HEADING="PART 405" SEQ="2">FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED</PARENT>
      <PARENT HEADING="Subpart X" SEQ="1">Rural Health Clinic and Federally Qualified Health Center Services</PARENT>
      <PARENT HEADING="" SEQ="0">Payment for Rural Health Clinic and Federally Qualified Health Center Services</PARENT>
    </ANCESTORS>
  </FDSYS>
  <SECTION>
    <SECTNO>§ 405.2463</SECTNO>
    <SUBJECT>What constitutes a visit.</SUBJECT>
    <P>(a) <E T="03">Visit.</E> (1) A visit is a face-to-face encounter between a clinic or center patient and a physician, physician assistant, nurse practitioner, nurse-midwife, or visiting nurse.</P>
    <P>(2) For FQHCs, a visit also means a face-to-face encounter between a patient and a qualified clinical psychologist or clinical social worker.</P>
    <P>(3) Encounters with more than one health professional and multiple encounters with the same health professional that take place on the same day and at a single location constitute a single visit, except when one of the following conditions exist:</P>
    <P>(i) After the first encounter, the patient suffers illness or injury requiring additional diagnosis or treatment.</P>
    <P>(ii) For FQHCs, the patient has a medical visit and an other health visit, as defined in paragraphs (b) and (c) of this section.</P>
    <P>(4) <E T="03">Payment.</E> (i) Medicare pays for two visits per day when the conditions in paragraph (a)(3) of this section are met.</P>
    <P>(ii) In all other cases, payment is limited to one visit per day.</P>
    <P>(b) <E T="03">Medical visit.</E> For purposes of paragraph (a)(3) of this section, a medical visit is a face-to-face encounter between an FQHC patient and a physician, physician assistant, nurse practitioner, nurse-midwife, or visiting nurse.</P>
    <P>(c) <E T="03">Other health visit.</E> For purposes of paragraph (a)(3) of this section, an <PRTPAGE P="243"/>other health visit is a face-to-face encounter between an FQHC patient and a clinical psychologist, clinical social worker, or other health professional for mental health services.</P>
    <CITA>[61 FR 14657, Apr. 3, 1996]</CITA>
  </SECTION>
</CFRGRANULE>
