effective January 1, 2010, the Current Procedural Terminology consultation codes (ranges 99241-99245 and 99251-99255) are no longer recognized for Medicare Part B payment. Effective for services furnished on or after January 1, 2010, providers should code a patient evaluation and management visit with E/M codes that represents WHERE the visit occurs and that identify the COMPLEXITY of the visit performed. See the Key Points section of this article for details.
recognize AMA Procedure consultation codes (ranges 99241-99245, and 99251-
99255) for inpatient facility and office/outpatient settings where consultation
codes were previously billed for services in various settings.
99241-99245 and 99251-99255 and should instead use the E/M codes that
most appropriately describe the E/M services that could be described by the
Procedure consultation codes.
furnishing specialty care. All other physicians who perform an initial evaluation
on this patient shall bill only the E/M code for the complexity level performed.
• However, claims that include the “-AI” modifier on codes other than the initial hospital and nursing home visit codes (i.e., subsequent care codes or
outpatient codes) will not be rejected and returned to the physician or provider.
admitted to the hospital as inpatients and who are discharged on the same
date, the physician should report Procedure codes 99234-99236 (e.g., Code 99234- Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date). If the patient is an inpatient and another physician evaluation is necessary, the physician would bill the initial hospital day code as appropriate (99221-99223).
Otherwise, the physician should use the new or established patient office or
other outpatient visit codes for a necessary evaluation.
physicians and qualified NPPs should report the Procedure codes (99201 – 99215) depending on the complexity of the visit and whether the patient is a new or established patient to that physician.