CMS issues coding guidance for consultations

Why This Topic Matters

Consultation reporting changed significantly after CPT deletions and CMS issued follow-up instructions that affect how services are documented and reported across care settings. Understanding the scope of the Medicare guidance helps organizations align coding, documentation, and billing workflows with current policy expectations.

Article Sections

1. Consultation coding guidance after CPT deletions

   Introduces CMS guidance issued in response to changes in the CPT book and explains the general reporting context for consultation services across care settings.

2. Follow-up consultations

   Covers Medicare instructions for reporting follow-up consultation services in hospital, nursing facility, and office settings.

3. Second opinion consultations

   Summarizes guidance for second-opinion consultation scenarios in institutional and office environments, including situations where consultation requirements are not met.

4. Consultations by NPPs

   Describes CMS guidance on consultation services furnished by qualified nonphysician practitioners, along with documentation and practice-setting considerations.