BC Advantage - 2017 Issue 8

The Incredible Disappearing Consultation

In January of 2010, CMS ceased payment of CPT codes for consultations (99241 through 99245 for outpatient, and 99251 through 99255 for inpatient). This drastic step was preceded by several years of CMS and its administrative carriers (MACs) attempting to educate the provider community on documentation guidelines for consultations. Unfortunately, CERT audits, and the MAC probe audits those results spawned, showed that providers were still not meeting CMS standards.In the years since, commercial payers have slowly followed CMS' lead in halting payments for consultations. Beginning October 1, 2017, United Healthcare (UHC) will join this list. In announcing this...

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