January 17, 2019
Last year, we required primary care providers to include a CPT code when submitting a Medicare Advantage (MA) patient referral to a specialist. We heard from many providers that this caused confusion, so for 2019 we’re phasing out requiring the code for MA referrals.
Here’s some information about the change:
- On January 1, we updated the fax referral form and removed the CPT code field. You can now fill out and fax the form without the CPT code requirement.
- When you call in a referral to Medical Management, they’ll no longer ask you for a code.
- Your written confirmation for your referral request will include a default office visit CPT code. This doesn’t mean that the specialist’s claim will deny if the CPT code doesn’t match. It’s for our internal process only.
- If you use the online referral tool, you’ll still need to add the code for now. It’ll take us some time to reconfigure the tool. If you use the referral tool, we recommend that you select an office visit code. The specialist’s claim will not deny if the CPT code doesn’t match the CPT on the referral.
We’ll let you know when we’ve updated the tool.