CMS Revises Consultation Services Payment Policy

Effective Jan. 1, Medicare will no longer recognize CPT consultation codes for payment of services provided to Medicare Part B beneficiaries.

CMS is deleting several consultation codes -- 99251 to 99255 and 99241 to 99245 -- and replacing them with the CPT codes noted below.

Cynthia Hughes, C.P.C., an AAFP coding specialist, said physician services currently billed as consultations should be reported as initial hospital care or initial nursing facility care (CPT codes 99221 to 99223, or 99304 to 99306) in inpatient settings and as office or other outpatient evaluation and management services (CPT codes 99201 to 99215) in outpatient settings.

CMS published instructions for physicians on the new system in a recent issue of MLN Matters, (9-page PDF; About PDFs) the agency's online newsletter dedicated to informing participating health care professionals about Medicare news.

"If physicians admit patients to the hospital after Jan. 1, they will have to append the CPT code for the initial care charges with the newly created "AI" modifier to indicate that they are the admitting physician," said Hughes.

Hughes said she gleaned two key points of interest from a CMS conference call on the issue. Physicians should note that

The question of how to handle billing when Medicare is the secondary payer on the claim is addressed in the MLN Matters article beginning on page 5. Hughes urged AAFP members to share the article with office staff whose duties include billing, coding or compliance.