Concurrent care coverage by Medicare

Medicare is a Federal Health Insurance Program administered by the Health Care Financing Administration for the elderly and certain disabled persons. The Texas Medicare carrier disseminates information and develops educational programs for improved understanding. "Concurrent care" exists when services are performed by more than one physician during a period of time for the same patient. Since Medicare does not have specialty designations for endocrinology, oncology, rheumatology, hematology, and infectious disease physicians, an X6 modifier is used for recognition. Services by two physicians of the same specialty or subspecialty rarely warrant coverage, but services by one physician and later care by another physician for an acute episode do warrant coverage. Emergency department codes should be used when care is given in that department and appropriate modifiers should be used by second- and third-opinion consultants in order to avoid the appearance of concurrent care. Diagnosis related to specialty and documentation of acute situations help avoid denial for "not reasonable or necessary" services. Physicians should use the "Waiver of Liability" when concurrent care seems necessary but is not likely to be covered by Medicare.