Forum - Questions & Answers

Jan 13th, 2020 - nate0922 7 

coding question

Are consult codes 99251-99255 for inpatient recognized by Medicare? If not, what codes do we use?

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Jan 14th, 2020 - ChrisW   160  1 

CMS has eliminated the use of all consultation codes.

CMS has eliminated the use of all consultation codes for inpatient and outpatient. However, the exception being CMS may cover telehealth consultation HCPCS G-Codes. Instead of reporting a consultation service, CMS will cover an E/M service if it is medically reasonable and necessary.

According to CMS, "Effective January 1, 2010, local Part B carriers and/or A/B MACs will no longer recognize AMA CPT consultation codes (ranges 99241-99245, and 99251- 99255) for inpatient facility and office/outpatient settings where consultation codes were previously billed for services in various settings".

Refer to MLN MM6740 -Revisions to Consultation Services Payment Policy

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