How to use E/M visit codes after no more consult billing

Why This Topic Matters

The policy affects how common evaluation and management services are reported and paid under Medicare, especially for practices that frequently billed consults. Understanding the transition helps billing teams prepare for payment changes, payer differences, and related modifier and global-period updates.

Article Sections

1. Medicare consult billing ends and visit codes take its place

   Introduces the Medicare policy change and the shift away from consult reporting. It frames the transition in terms of inpatient and outpatient E/M services and the timing of implementation.

2. Budget neutrality and payment changes

   Summarizes the CMS rationale for the change and the related payment adjustments made to support budget neutrality. It also notes the broader impact on E/M reimbursement patterns.

3. Transfer of care change prompted calls for delay

   Discusses the transfer-of-care issue and why some stakeholders wanted CMS to delay implementation. It also addresses how CMS and the AMA framed the distinction between transfer of care and consultation.

4. CMS crosswalk and payment comparisons

   Describes CMS’s crosswalk approach for budget-neutrality calculations and compares how different service settings may be affected. The section focuses on the transition from consultation services to visit-based coding.

5. A new modifier

   Notes the introduction of a new modifier associated with the transition and its intended role in reporting care coordination. It also mentions that CMS planned additional education materials.

6. Bundled payments

   Covers CMS’s handling of bundled payment updates for services with global periods. The discussion is limited to the general effect on payment adjustments during the transition.