Payers react to new Medicare consultation code policy

The Medical Society of Virginia (MSV) has contacted local health insurance plans to understand how each will react to Medicare’s policy of no longer recognizing CPT consultation codes (CPT code 99241 to 99245; and 99251 to 99255) for inpatient facility and office/outpatient settings. 

• The Virginia Department of Medical Assistance Services (DMAS) has not published guidance at this time.  Physicians are to continue to follow current CPT guidelines regarding billing consultation codes.
• Anthem has not published guidance at this time.   Physicians are to continue to follow current CPT guidelines regarding billing consultation codes.
• Coventry Southern Health has not published guidance at this time.  Physicians are to continue to follow current CPT guidelines regarding billing consultation codes, but should continue to monitor guidance from Southern Health for updates to this policy.
• Aetna is expected to publish guidance in its next “Office Links” publication.  Commercial products will continue to follow current CPT guidelines regarding billing consultation codes.  Aetna’s Medicare private fee-for-service plans will follow the new CMS guidelines for consultations beginning January 1, 2010.
• As previously reported, United Healthcare (UHC) has published guidance that its commercial plans will continue to follow current CPT guidelines regarding billing consultation codes.  UHC Medicare Solutions plans will follow the new CMS guidelines for consultations beginning January 1, 2010.  AmeriChoice Medicaid health plans will follow the lead of state Medicaid plans.

The new CMS policy does not apply to Medicare Advantage plans; however, plans may individually elect to apply the new policy.

We strongly encourage you to contact your contracted carriers for more information and to carefully review guidance from each health plan as it is probable that these policies will be amended in the future.  We will continue to update you on additional guidance as it is received.