Billing consult code to Medicare - New updated rule

New Medicare Coding for Consultation Services

As of January 1, 2010, Medicare no longer recognizes CPT procedure codes for consultation services (CPT codes 99241- 99245 and 99251-99255). This change represents a very significant change in Medicare payment policy; however, as of now, the change is for Medicare only. Commercial payors have not yet adopted similar guidelines when it comes to consultation services and providers should continue to use the consultation codes for all non-Medicare payors. Surgeons should check with each individual commercial  payor to determine if that payor is continuing to accept the 99241-99245 and 99251-99255.


When billing Medicare, providers will be required to use other Evaluation and Management (E/M) codes when they provide services that were previously coded as consultations. Specifically, for office or outpatient  consultations, Medicare will not recognize codes 99241- 99245, but will, instead, require providers to bill these services as new (99201- 99205) or established office/outpatient (99211-99215) visits. For inpatient consultations, Medicare will not recognize codes 99251-99255 but will instead require providers to bill these services as initial inpatient patient visits (99221-99223). For inpatient initial hospital visits, the admitting physician will have to append a modifier, AI, in order for the consulting physician to get reimbursed. For Emergency Department consultations, which would have formerly been coded as outpatient consultations (99241-99245), will now be billed as Emergency Department visits (99281- 99285).

No comments:

Top Medicare billing tips