Medicare Carriers Manual Sec. B3 15506 - Consultations

Why This Topic Matters

Consultation policy affects whether a service is billed as a consultation or another type of visit, and the documentation requirements can directly impact claim accuracy and compliance. Understanding the policy helps practices align billing practices with Medicare expectations across multiple care settings.

Article Sections

1. A. Consultation Versus Visit

   Explains the general distinction between consultation services and other types of visits in Medicare guidance. The section also addresses the role of referral, reporting, and subsequent treatment responsibility at a high level.

2. B. Consultation Followed By Treatment

   Addresses consultation services when treatment follows after the initial consult-related encounter. The section focuses on the timing relationship between consultation and ongoing care.

3. C. Consultations Requested By Members of Same Group

   Covers consultation requests occurring within a physician group practice. The discussion is limited to the applicability of consultation policy in that setting.

4. D. Documentation For Consultations

   Summarizes the documentation expectations associated with consultation services. The section discusses how requests and reporting should appear in the record across settings.

5. E. Consultation for Preoperative Clearance

   Addresses consultation services related to preoperative evaluation. The section identifies the general setting and type of request involved.

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

   Discusses how postoperative management affects consultation billing when the same physician was involved in preoperative evaluation. The section also touches on postoperative care billing concepts in hospital and office contexts.

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

   Covers postoperative care scenarios in which another physician is asked to participate in management. The section distinguishes consultation-related considerations from concurrent care at a general policy level.