Changes in CMS Consultation Services Payment Policy

Effective January 1, 2010, Centers for Medicare & Medicaid Services (CMS) is eliminating the use of all consultation codes (inpatient and office/outpatient codes) for various places of service except for telehealth consultation G-code.  AMA CPT codes ranging from  99241-99245 and 99251-99255 will no longer be recognized for Medicare Part B Payment.

CMS has advised physicians to code patient evaluation and management visits with E/M codes that represent where the visit occurs and that identify the complexity of the visit performed.  A complete provider education article, published by CMS, is available here.

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  • Amy Whited

    CMS has eliminated the Medicare reimbursement for these codes effective January 1, 2010. It would be advisable to review all of your contracts with other insurers to determine if they will continue to reimburse these codes. It is not unusual for other insurers to reimburse only those codes reimbursed by CMS, however you should check your contract to confirm this.

  • Vicki Fisher

    Does deleting the consultations codes 99251-99255 for Medicare also apply to other insurance carriers. For example-if a pt has BC could we still use 99251?