CONSULTATION SERVICES
Effective for services furnished on or after January 1, 2010, Medicare no longer recognizes inpatient consultation codes (Procedure codes 99251–99255) and office and other outpatient consultation codes (Procedure codes 99241–99245) for Part B payment purposes.
However, telehealth consultation codes (Healthcare Common Procedure Coding System G0406–G0408 and G0425–G0427) are recognized for Medicare payment. Physicians and NPPs who furnish services that, prior to January 1, 2010, would have been reported as Procedure consultation codes, should report the appropriate E/M visit code to bill for these services beginning January 1, 2010.
Medicare no longer recognizes consultation CPT codes 99241-99245 and 99251-99255. This applies for both Medicare-primary and Medicare-secondary claims. Please Note: These codes are still valid CPT codes for 2010, and Blue Cross continues to accept these consultation codes. We have current allowable charges for these codes and any changes in allowable amounts or billing policies for these codes will be communicated to our providers with a 90-day notice. At this time, we do not anticipate any changes.
Per CMS, physicians and others must bill an appropriate Evaluation and Management code for the services previously paid using the consultation codes. If the primary payer for the service continues to recognize consultation codes, physicians and others billing for these services may either:
1. Bill the primary payer an Evaluation and Management code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with the same Evaluation and Management code, to Medicare for determination of whether a payment is due; or
2. Bill the primary payer using a consultation code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with an Evaluation and Management code that is appropriate for the service, to Medicare for determination of whether a payment is due.
Note: The first option may be easier from a billing and claims processing perspective.
Effective for services furnished on or after January 1, 2010, Medicare no longer recognizes inpatient consultation codes (Procedure codes 99251–99255) and office and other outpatient consultation codes (Procedure codes 99241–99245) for Part B payment purposes.
However, telehealth consultation codes (Healthcare Common Procedure Coding System G0406–G0408 and G0425–G0427) are recognized for Medicare payment. Physicians and NPPs who furnish services that, prior to January 1, 2010, would have been reported as Procedure consultation codes, should report the appropriate E/M visit code to bill for these services beginning January 1, 2010.
Medicare Payment Rules for Consultation Services
Medicare no longer recognizes consultation CPT codes 99241-99245 and 99251-99255. This applies for both Medicare-primary and Medicare-secondary claims. Please Note: These codes are still valid CPT codes for 2010, and Blue Cross continues to accept these consultation codes. We have current allowable charges for these codes and any changes in allowable amounts or billing policies for these codes will be communicated to our providers with a 90-day notice. At this time, we do not anticipate any changes.
Per CMS, physicians and others must bill an appropriate Evaluation and Management code for the services previously paid using the consultation codes. If the primary payer for the service continues to recognize consultation codes, physicians and others billing for these services may either:
1. Bill the primary payer an Evaluation and Management code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with the same Evaluation and Management code, to Medicare for determination of whether a payment is due; or
2. Bill the primary payer using a consultation code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with an Evaluation and Management code that is appropriate for the service, to Medicare for determination of whether a payment is due.
Note: The first option may be easier from a billing and claims processing perspective.
For more on this from the CMS, go to www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf and www.cms.hhs.gov/MLNMattersArticles/downloads/SE1010.pdf.
1. Consult and preventive codes
Usually we could not bill consult code and preventive code together.
2. Consult code for place of service 22
Should not file the consultation code claims with POS 22.
3. Consult codes 2010 for horizon blue cross blue shield
We can file the consult code to Horizon blue cross blue shield
4 Consult codes for medicaid
We can file the consult code to Medicaid
6. Consult codes for medicare advantage plans
Medicare advantage plans do not cover the consultation service.
7. Consult codes not accepted by commercials in Florida
We can file the consult code to some commercial insurance in Florida.
8. Consult with preventive billing
We could not file the preventive code with consultation.
9. Consultation and office visit billed together
We cannot bill the consultation code and office visit together for the same date of service.
10. Consultation code-99251-99255 accepted by medicare hmos
Medicare HMO plan does not cover the consultation service.
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S.No
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Insurance name
|
|
1
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Medicare
|
|
2
|
Humana (HMO)
|
|
3
|
Freedom Health
|
|
4
|
AVMED
|
|
5
|
Advantra Gold plus (
|
|
6
|
Universal Health
|
|
7
|
Wellcare
|
|
8
|
AARP Medicare completed
|
|
9
|
UHC (HMO)
|
|
10
|
|
|
11
|
PUP
|
|
12
|
QHP
|
|
13
|
Amerigroup
|
|
14
|
Citruscare
|
11. Consultation codes list
Office consultation code
99241
99242
99243
99244
99245
* Hospital Consultation code
99251
99252
99253
99254
99255
12. Consult code payment 2010 insurance
Below I have mentioned few insurance that we have received the payment for consult code
Aetna
BCBS
Cigna
Great West
Tricare
Golden Rule
Medicaid
UHC (Commercial non-HMO plans)
13. Consult codes coding billed with code 96372
We can file CPT 96372 along with Consultation code. And 96372 is injection admin code
14. Consult CPT code used by Aetna 2010
Aetna will processes the below set of consultation code.
Office – 99241 to 99245
Hospital – 99251 to 99255
