September 19, 2019
At the beginning of 2010, CMS no longer recognized the outpatient and inpatient consultation codes as valid codes and therefore were not reimbursed. Following these same CMS guidelines, Premera (LifeWise) also does not reimburse these consultation codes if the provider is on a 2010 or more current Resource Based Relative Value System (RBRVS) fee schedule. These consultation codes include the following CPT procedure codes:
- Outpatient consultation: 99241, 99242, 99243, 99244, 99245
- Inpatient consultations: 99251, 99252, 99253, 99254, 99255
Consultation services should be reported with an appropriate Evaluation and Management (E&M) code that represents the location where the visit occurred and the level of complexity of the visit performed. Such locations include but are not limited to the office or other outpatient setting, the inpatient hospital setting or nursing facility setting.
Submission of any of the above noted consultation codes will result in a denial of reimbursement, so review the Payment Policy Consultation Code Services for further details and submit an appropriate E&M visit code instead.