Part B News | Private payers no longer honoring consult codes UnitedHealthcare, for example, recently communicated to members that it has implemented the CMS regulations for its UnitedHealthcare Medicare Solutions, including SecureHorizons, AARP MedicareComplete, Evercare, and AmeriChoice Medicare Advantage benefit plans, but says it will continue to reimburse commercial plans forCPT codes 99241-99245 and 99251-99255 at this time. xref 219 0 obj Cigna to Eliminate Consultation Codes - The Rheumatologist Coding and Modifier Information Getting Paid for Screening and Assessment Services | AAFP B{rZyNR EA kH:VuI`uy3ITs2R]2rlS!>Q`ZZpW#=Q;^hRLf$Az\* 0000028543 00000 n 0000003954 00000 n 229 0 obj If the documentation supports an initial hospital service, use codes 99221-99223, initial hospital care codes. C CatchTheWind Guest If youre wondering why CMS initiated the change in policy in the first place, you may want to readthe article Is it Time to Eliminate Consultation Codes? in the Archives of Internal Medicine. Do not use CPT consultation code ranges 99241-99245, 900-3925-0617 99251-99255 or HCPCS consultation codes G0406-G0408, G0508, G0509 or G0425 . <> At first, most continued accepting the codes. If you pass the claim on to the MSP using the consult code, the . PDF Consultation Services Policy, Professional - UHCprovider.com For all other Medicaid states, however, AmeriChoice currently follows the UnitedHealthcare commercial position and will continue to pay for consult codes until directed otherwise by a state to pursue other strategies. My question to you is are you meeting all three requirements of a consultation? Its also job security. The advantages to using the consult are codes are twofold: they are not defined as new or established, and may be used for patients the clinician has seen before, if the requirements for a consult are met..
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