The final rule under CMS 2370-F clarifies that the 60 percent threshold for eligibility is

The 60 percent threshold is based on the number of billed services as identified by individual billing codes for the primary specialty being asserted. That is, the numerator equals total billed codes for Evaluation & Management (E&M) services for the primary specialty, plus vaccine administration services, and the denominator equals the total number of billed codes. Please note that a state may choose to use paid billing codes/services in place of billed codes.

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• This FAQ was released as part of a larger set. View the full set. (PDF, 52.92 KB)