Medicare Advantage Policies
MA PPO Host Policies
Medicare Advantage Preferred Provider Organization (MA PPO)
Applicable to enrollees from other Blue Cross Blue Shield Medicare Advantage Plans who obtain health care services within the 5-county Philadelphia service area.
News & Announcements
Notification Issue Date:
5/3/2018 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.
This policy is consistent with Medicare’s coverage determination.
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.
Centers for Medicare & Medicaid Services (CMS). MLN Matters® Number: MM6740. Revisions to Consultation Services Payment Policy. Available at:
CPT Procedure Code Number(s)
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
Version Effective Date:
Version Issued Date:
Version Reissued Date:
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