Wiki UHC Consultation Policy


Staten Island, NY
Best answers
Now that UHC is no longer accepting consult codes, does anyone know what codes UHC wants you to bill for patients seen in the hospital setting? For example, should you follow CMS and report 99222 for the first time a patient is seen in the hospital setting, or would they require 99232 instead?

Thanks for this. I have read this before, but it is not entirely clear. Do you know if this statement means to bill 99222 for hospital visits?
"When services are rendered at the request of another physician or appropriate source, care providers should submit an appropriate E/M service in alignment with either the 1995 or 1997 CMS coding guidelines."
If the service rendered at inpatient setting, then we can bill appropriate admit CPT code, based on the level supported in document.

Just assume, the service performed inpatient consult and document supports to bill CPT 99254 (
  • A comprehensive history;
  • A comprehensive examination; and
  • Medical decision making of moderate complexity.
The appropriate code is 99222, based on key component

Depending on the level of care, you could potentially bill initial care 99221-99223 or subsequent care 99231-99233 codes