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Thread: Consultation codes

  1. #1
    Join Date
    Apr 2007

    Default Consultation codes

    AAPC: Back to School
    Good morning fellow listers....

    We know that Medicare is no longer going to pay for consultation codes.

    My question is this:

    Primary payer will pay for consultation codes.

    Secondary Payor is Medicare.

    So if we submit the service to the primary payor and they pay 100% then we do not have an issue but if the primary payor does not pay at 100% and we have to submit to secondary insurance how will this be handled as Medicare will not pay for consultation codes? Do we change the consult code to one of the crosswalk codes and then submit to the secondary?

    Soooo confusing!!!! Thanks

  2. #2
    Join Date
    Apr 2007
    Kansas City, MO


    Double check with your local carrier, but ours has told us that in this type of scenario only, it is ok to change your codes to send the claim to Medicare as the secondary payer. They told us we could choose to do it that way, or to just bill the primary payer a non-consult code. While of course many will choose to bill the higher paying consult code to the primary insurance, some billing systems do not allow for the change in coding when payment is involved. And of course the extra work might be an issue. We, at our facility have choosen to just bill the non-consult code. We figured it honestly is not worth the extra work, for the low anount of MSP patients we have.

  3. #3


    The information I have received is only for the situation when Medicare is the 2nd payor. Per their webinar, you would bill the consult code to your commercial payor and then need to change the code to the cross walked code then to send it on to Medicare as secondary. I would safely suggest to do the same if the insurance situation is reversed.

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