Oncology & Hematology Coding Alert

Provider Requirement: 90460-90461 Show Importance of ‘Qualified Health Care Professional’ Definition



For accurate claims, distinguish these professionals from 'clinical staff.'

The definition of "other qualified health care professional" didn't make it into the CPT® 2012 manual, but you need to know and apply this definition all the same.

The AMA lists the definition as part of the "CPT® 2012 Errata" on its website (www.ama-assn.org/resources/doc/cpt/cpt-corrections.pdf). The definition is as follows:

"A 'physician or other qualified health care professional' is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service. These professionals [...]

- Published on 2012-01-17

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