Date Issued: 9/8/2014
(Medicare HIP/Commercial HIP/Vytra/Medicare PPO/CompreHealth Plans)
To be consistent with Centers for Medicare & Medicaid Services guidelines, consultation codes are no longer reimbursable and have been removed from our prevailing plan fee schedule as of November 1, 2010. This change applies to all HIP and Vytra providers who received a notice, contract amendment, or both on or after July 2010.
Effective August 1, 2014, this policy also applies to nonparticipating providers who see patients in our Medicare PPO plans.
The affected consult codes are:
• 99241 - 99245
• 99251 - 99255
Instead, please use Office Visit and Hospital Care codes, if applicable, to bill for your services.
*HMO Medicaid LOB excluded as of 04/30/2019