We are pleased to announce the implementation of a new physician specialty code, F6, used to indicate the specialty designation for an epileptologist. The new code, created by the Centers for Medicare & Medicaid (CMS) is the result of a collaborative effort among specialty societies that included submitting a request to the agency requesting the new code while also educating CMS on the need for the code. The new code was created to recognize the specialized expertise of epileptologists in diagnosing and treating epilepsy, providing an essential resource for healthcare providers, and improving patient care. Physicians may enroll or update their specialty to reflect the new specialty code, which is “F6”. The formal CMS change to the Medicare Claims Processing Manual and notice sent to Medicare Administrative Contractors is available here.

Implementation Date:

The new specialty code for epileptologists, F6 is effective July 1, 2024.

Provider Education: To enroll as a Medicare Provider for the first time, please follow the instructions here. If you are already enrolled as a Medicare Provider and wish to change your specialty code or add the new code use either the electronic version of the application in PECOS or the paper version CMS-855I (PDF). Providers may use two specialty designations, if needed. To assist providers with this transition, the CMS has released an MLN article that includes provider education on the new code. This article also offers information on the usage and benefits of the specialty code.

Eligible Providers:

Physicians self-designate their Medicare physician specialty upon enrollment in the Medicare program. Medicare physician specialty codes describe the specific/unique types of medicine that physicians (and certain other suppliers) practice. The new specialty code may be used by Board-certified epileptologists and neurologists who have additional training and expertise in epilepsy care.

Benefits of Using the Specialty Code:

1. Accurate Provider Identification: The new code allows for precise identification of epileptologists within the healthcare system, ensuring that patients receive specialized care from qualified professionals.

2. Streamlined Reimbursement: The specialty code facilitates accurate billing and reimbursement processes. The new designation will allow CMS to distinguish epileptologists from general neurologists when billing for Medicare services. Previously, no mechanism existed for CMS to accurately identify this category of physician for quality and payment programs. Some local Medicare carriers have denied claims in the past, citing duplicate billing, when a neurologist and an epileptologist from the same practice have billed for patient evaluation services on the same day.

3. Data Collection and Analysis: The code helps in collecting and analyzing data specific to epilepsy care, aiding in research and policymaking.

The Societies worked together on a Fact Sheet with more information and instructions on how to enroll or update your designation with CMS.

Contact NAEC with any questions at info@naec-epilepsy.org.