AHA Coding Clinic® for HCPCS - 2010 Issue 1; FOR your INFORMATION
Consultation Services
Effective January 1, 2010, the CPT codes for office consultation services (99241-99245) and the inpatient consultation services (99251-99255) are no longer recognized for Medicare Part B payment under the Physician Fee Schedule. In addition, effective on the same date, these codes will not be recognized for Method II Critical Access Hospitals when billing for services of those physician and non-physician practitioners who have reassigned their billing rights. Refer to Change Request #6740, released December 14, 2009 for additional information. Note: Please do not confuse this information with facility reporting. Under the hospital outpatient prospective payment system (OPPS), since CY...
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Article Overview
This short policy notice summarizes changes to consultation service billing under Medicare, with attention to CPT consultation codes, Medicare Part B payment under the Physician Fee Schedule, and Method II Critical Access Hospital billing. It also distinguishes professional billing policy from hospital outpatient reporting under OPPS and references a CMS Change Request for further details. The article is relevant to coders, billers, compliance staff, and revenue cycle professionals who work with evaluation and management services in Medicare settings.
Why This Topic Matters
It helps readers recognize that consultation service code usage is affected by Medicare-specific payment rules and that hospital outpatient reporting follows a separate pathway from professional billing.
What You Will Learn
- How Medicare policy affects consultation service billing
- Which billing settings are addressed by the notice
- How hospital outpatient reporting is distinguished from professional billing
- Where to look for related CMS implementation guidance
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Revenue cycle teams
- Hospital outpatient billing staff
- Physician practice administrators
Code Ranges Discussed
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