Commercial

Consultation Services
00.01.69


Policy

Current Procedural Terminology (CPT) consultation codes are not eligible for reimbursement. The appropriate level of Evaluation and Management (E&M) service should be reported.

For a list of CPT consultation codes, refer to the Coding Table in this policy.

Guidelines


Description

A consultation is a type of service provided by a physician or other qualified healthcare professional whose opinion or advice regarding the evaluation and management (E/M) of a specific clinical problem is requested by another physician or other qualified healthcare professional.

References


Center for Medicare and Medicaid Services [CMS]. Medicare Claims Processing Manual: Chapter 12 - Physicians/Nonphysicians Practitioners. 07/25/2019. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf. Accessed November 23, 2019.

Center for Medicare and Medicaid Services [CMS]. Revisions to Consultation Services Payment Policy. Medical Lives Network Matters® Number: MM6740 Revised.November 8, 2011. Available at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM6740.pdf. Accessed: November 23, 2019.


Coding

CPT Procedure Code Number(s)

THE FOLLOWING CODES ARE USED TO REPRESENT CONSULTATION SERVICES
99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255


ICD - 10 Procedure Code Number(s)
N/A

ICD - 10 Diagnosis Code Number(s)
N/A

HCPCS Level II Code Number(s)
N/A

Revenue Code Number(s)
N/A


Coding and Billing Requirements


Policy History

4/15/2020
4/15/2020
 
00.01.69
Claim Payment Policy Bulletin
Commercial
No