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Thread: Consultation

  1. #1
    Join Date
    Apr 2007

    Default Consultation

    AAPC: Back to School
    Can a nurse get paid for a consult for Medicaid?

    Patricia Bailey, CPC, CPMA
    Coding Specialists
    Horizon Management Services
    213 Ridgefield Court
    Asheville,NC 28806

  2. #2
    Join Date
    Apr 2007
    North Carolina


    No. NP and PA's may be billable according to state law.

    North Carolina Medicaid’s Use of CPT Consultation Codes

    Effective January 1, 2010, CMS eliminated the use of all consultation CPT procedure codes. This includes inpatient codes (99251 through 99255) and office/outpatient codes (99241 through 99245) for applicable places of
    service. At this time, the N.C. Medicaid Program will not change the way it reimburses for consultation services. However, when billing for consultation services provided to dually eligible recipients, providers should bill according to Medicare’s requirements.

    Former Medicare guidelines allowed NP and PA's to conduct consultations if it was within their scope of practice/state law.

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