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Consultation Services
MA00.049a

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

Centers for Medicare and Medicaid Services [CMS]. Evaluation and Management Services Guide. Medical Learning Network Booklet: MLN 006764. 2/2021. Available at: https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/eval-mgmt-serv-guide-icn006764.pdf. Accessed April 6, 2022​.

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 April 4, 2022.

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

6/6/2022
6/6/2022
MA00.049
Claim Payment Policy Bulletin
Medicare Advantage
No