Medicare Advantage

Consultation Services
MA00.049

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


This policy is consistent with Medicare’s coverage determination.

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​

Centers for Medicare & Medicaid Services (CMS). MLN Matters® Number: MM6740. Revisions to Consultation Services Payment Policy. Available at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm6740.pdf



Coding

CPT Procedure Code Number(s)
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

8/1/2018
8/1/2018
10/7/2020
MA00.049
Claim Payment Policy Bulletin
Medicare Advantage
No