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Presbyterian no longer paying Consultations

  1. #1
    Question Presbyterian no longer paying Consultations
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    My office just received a letter from Presbyterian Health Plan that states, in short, they will no longer be paying consultation codes 99251-99255 and 99241-99245 per the 2010 Medicare Fee schedule. Physicians are now required to choose an appropriate E/M code based on where the visit occurs/site of service and the complexity of the visit performed. First, has anyone else gotten this letter? Second, would this just be coded with the approriate Office visit codes and H/P codes for hospital? Any insight relating this would be great.

    Thanks Much

  2. #2
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    Quote Originally Posted by cgant View Post
    My office just received a letter from Presbyterian Health Plan that states, in short, they will no longer be paying consultation codes 99251-99255 and 99241-99245 per the 2010 Medicare Fee schedule. Physicians are now required to choose an appropriate E/M code based on where the visit occurs/site of service and the complexity of the visit performed. First, has anyone else gotten this letter? Second, would this just be coded with the approriate Office visit codes and H/P codes for hospital? Any insight relating this would be great.

    Thanks Much
    A lot of commercial payers are following Medicare's lead by no longer recognizing the Consultation codes in CPT. You would bill the appropriate New or Established patient E/M codes based on the site of service. It is happening everwhere and is not a big surprise.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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