Medicare Carriers Manual Sec. B3 15506

Why This Topic Matters

Understanding this guidance helps practices distinguish consultation scenarios from other visit types and document requests and reports appropriately. It also supports compliant handling of pre-operative and post-operative care arrangements that may affect which E/M category is reported.

Article Sections

1. Consultations

   Introduces the consultation topic and the CPT consultation service code range discussed in the manual section.

2. A. Consultation Versus Visit

   Explains the general distinction between consultation services and other visit types, along with the related documentation emphasis.

3. B. Consultation Followed By Treatment

   Addresses consultation scenarios in which treatment follows the initial service and how subsequent care is described at a high level.

4. C. Consultations Requested by Members of Same Group

   Covers consultation requests involving physicians within the same group practice and points to related CPT guidance.

5. D. Documentation For Consultations

   Summarizes documentation expectations for consultation requests and written reports across different care settings.

6. E. Consultation for Preoperative Clearance

   Discusses consultation services requested in connection with pre-operative clearance and the general billing context.

7. F. Post-Operative Care By Physician Who Did Pre-Operative Clearance Consultation

   Addresses post-operative management by a physician who previously performed a pre-operative consultation and the related care setting distinctions.

8. G. Surgeon's Request That Another Physician Participate In Post-Operative Care

   Describes a post-operative care scenario involving another physician’s participation and the related distinction from consultation services.