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There is 2024 Medicare C D Appeals Guidance Update (cms.gov)-https://www.cms.gov/medicare/appeals-and-grievances/mmcag/downloads/parts-c-and-d-enrollee-grievances-organization-coverage-determinations-and-appeals-guidance.pdf

I was always under the impression that they do in a similar fashion. Recent reserach bears this out. There is an excellet website that CMS provides, which outlines this information in great detail. Please visit https://www.cms.gov/Medicare/appeals-grievances/managed-care#:~:text=Medicare%20health%20plans%2C%20which%20include,the%20requirements%20for%20grievance%2C%20organization It provides in great details the answers to your question. In essence the answer to your question is thus yes!

You underwent actually a SMRC audit with Noridian and those audits need to be taken very seriously. Yes, ALL minor procedures technically have some E/M built into the code. So, whether it is a new patient or established patient if all you are doing is the nail procedure, then that is all you get paid for. The NCCI clearly has the E/M as requiring the Modifier 25 if it is significant and distinct when paired with CPT 11730 or 11750. The question you need to ask yourself, does that patient need that minor procedure that same day? Or does the patient have a cellulitis in the toe in addition to the nail deformity? You have to show CC/HPI having 2 different issues, the examination should be problem focused, the diagnoses should be distinct and then you must document "Medical Management" that is not part of the minor procedure most likely prescribing an antibiotic for the infection to justify that E/M with either CPT 11730 or 11750. This policy is CMS/Medicare, but many private insurances follow CMS guidelines, and it is your responsibility to know.