Some plans still pay higher fees for consults — but don’t mix them up with transfers

Why This Topic Matters

Consultation billing remains relevant for organizations that bill multiple payer types, but requirements vary and can affect claim acceptance. The article helps readers identify where consults may still apply, what documentation themes are emphasized, and why payer-specific policy review matters.

Article Sections

1. Consultation codes and Medicare policy history

   This section reviews the background of consultation services and the Medicare policy shift that ended payment for them. It also summarizes oversight concerns that contributed to that change.

2. Commercial payer policies and current changes

   This section discusses how some non-Medicare payers have handled consultation services over time and notes examples of payer policy updates. It emphasizes the need to verify current rules across a payer mix.

3. How to confirm consults: request, render, report

   This section outlines general documentation themes used to support consultation claims. It focuses on the broad elements expected in the request, opinion, and response workflow.

4. Consult sources and transfer-of-care issues

   This section addresses who may initiate a consultation and how transfer-of-care situations can affect whether a service is treated as a consult. It also distinguishes appropriate request sources from situations that are not considered consultation requests.