Evaluation and Management (E/M) Services - Usage of the GE Modifier for Primary Care Exceptions
There are Evaluation and Management (E/M) services that a resident can perform without the presence of a teaching physician under the primary care exception. These services should be billed with the GE modifier. Per CMS IOM 100-04, Ch. 12, Section 100.1.1.C, (http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf) 
886KB, the services that can be billed with the GE modifier are limited to specific E/M codes.
"C. Exception for E/M Services Furnished in Certain Primary Care Centers
Teaching Physicians providing E/M services with a Graduate Medical Education (GME) program granted a primary care exception may bill Medicare for lower and mid-level E/M services provided by residents. For the E/M codes listed below, teaching physicians may submit claims for services furnished by residents in the absence of a teaching physician:
New Patient - 99201, 99202, and 99203
Established Patient - 99211, 99212, and 99213
Effective January 1, 2005, the following code is included under the primary care exception: G0344 - Initial preventive physical examination; face-to-face visit services limited to new beneficiary during the first 6 months of Medicare enrollment."
If codes other than the ones listed above are billed with the GE modifier, the services will be returned as Unprocessable.
