CONSULT ELIMINATION: Let These 5 Facts Guide You Now That Consults No Longer Apply

Why This Topic Matters

It helps readers understand which Medicare claims practices changed, which payer rules may still differ, and what official CMS guidance affects inpatient and consultation-related E/M reporting.

Article Sections

1. Modifier AI and inpatient physician reporting

   Introduces the new CMS modifier associated with inpatient physician reporting and explains the broader context for its use after consult payment changes.

2. Understanding the principal physician of record

   Discusses CMS terminology for the physician overseeing a patient’s care and how that role is described in Medicare guidance.

3. ABNs and consultation services

   Addresses the relationship between advance beneficiary notices and Medicare consultation services, including CMS commentary on when ABNs apply.

4. Medicare Advantage and other payers

   Explains that the consult payment policy is described as applying to Medicare fee-for-service claims and not necessarily to other payer types.

5. Crosswalks and selecting the most appropriate E/M code

   Warns against relying solely on crosswalk references and points readers to CMS guidance on choosing the most appropriate evaluation and management code.