Thursday, July 8, 2010

Billing office and emergency consult code

New Medicare Coding for Consultation Services

Crosswalks for Office/Outpatient Consultations


CPT Consultative Services Code CPT E/M Codes for Crosswalking Modifier Required
99241 99201 (new patient level 1) or 99211
(established patient level 1)		 No
99242 99202 (new patient level 2) or 99212
(established patient level 2)		 No
99243 99203 (new patient level 3) or 99213
(established patient level 3)		 No
99244 99204 (new patient level 4) or 99214
(established patient level 4)		 No
99245 99205 (new patient level 5) or 99215
(established patient level 5)		 No






Crosswalks for Emergency Department  Consultations not requiring admission of patient into inpatient facility



CPT Consultative Services Code CPT E/M Codes for Crosswalking Modifier Required
99241 99281 (ER visit level 1) No
99242 99282 (ER visit level 2) No
99243 99283 (ER visit level 3) No
99244 99284 (ER visit level 4) No
99245 99285 (ER visit level 5) No
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download