Payers Axe Consultation Codes
By Ellen Terry

UHC_Etip

Medicare did it in 2010, and now some private payers are following suit.

Both Cigna and UnitedHealthcare (UHC) have announced that starting in October, they will no longer pay for CPT consultation codes 99241-99245 – office consultations – and 99251-99255 – inpatient consultations.

UHC’s policy change becomes effective Oct. 1, as outlined in its March bulletin. Cigna’s July newsletter says Cigna’s policy takes effect Oct. 19. 

After those dates, you’ll need to submit claims to UHC and Cigna with the appropriate nonconsultative evaluation and management code that describes the service, including where it occurred and the complexity of the visit. 

UHC had planned to stop paying for the CPT consultation codes in 2017, but agreed to delay this policy change after receiving pushback from the Texas Medical Association and other medical societies, who argued that the policy "will only create another barrier" to physicians' ability to care for patients, in light of "widespread changes afoot for the United States health care system.”

 

Last Updated On

August 07, 2019

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Ellen Terry

Project Manager, Client Services

(512) 370-1391

Ellen Terry has been writing, editing, and managing communication projects at TMA since 2000. She hails from Victoria, Texas; has a journalism degree from Texas State University; and loves to read great fiction. Ellen and her husband have two grown sons and a couple of cats.

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