News and Updates >> Client Update
Medicare is no longer reimbursing for Consult Codes as of January 1, 2010
As everyone is probably aware effective January 1,2010 MCR will no longer recognize any consultation code whether inpatient (99251-99255) or out patient (99241-99245).
CPT Codes for new patients (99201-99205) or established patients (99211-99215) should be used to replace consultations in the office/outpatient setting.
CPT codes in the inpatient hospital setting (99221- 99223) should be used to replace inpatient consultations codes (99251-99255), and for nursing facility consultations, use codes (99304-99306).
Suggested Crosswalk
2009 2010
99241 99201 (new)
99211 (est)
99242 99202(new)
99212(est)
99243 99203(new)
99213(est)
99244 99204(new)
99214(est)
99245 99205(new)
99215(est)
99251 99221(initial hospital care)
99304(nursing facility, initial)
99252 99221(initial hospital)
99222(initial hospital)
99304(nursing facility, initial)
99253 99222(initial hospital)
99305(nursing facility, initial)
99254 99222(initial hospital)
99223(initial hospital)
99305(nursing facility, initial)
99306(nursing facility, initial)
99255 99223(initial hospital)
99306(nursing facility, initial)
As of now, for any commercial or private insurance, no information has been released by other third party payers regarding payment for consultation codes. Any consultation claim submitted with a commercial insurer, such as Blue Cross or Aetna who is the primary carrier using the eliminated consultation codes when Medicare is secondary would result in a denial for the secondary claim by Medicare. In those instances, where Medicare is secondary, you may want to consider using the new guidelines for reporting consultation codes.
For more information please see the CMS website to read the following update from Medicare:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf