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Notification Issue Date:
1/15/2020 12:00 AM
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.
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.
Center for Medicare and Medicaid Services [CMS]. Medicare Claims Processing Manual: Chapter 12 - Physicians/Nonphysicians Practitioners. 07/25/2019. Available at:
. 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:
. Accessed: November 23, 2019.
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)
ICD - 10 Diagnosis Code Number(s)
HCPCS Level II Code Number(s)
Revenue Code Number(s)
Coding and Billing Requirements
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