Medicare and Consultation Services in 2010
Beginning Jan. 1, 2010, Medicare no longer recognized consultation codes.
Physicians providing consultation services to patients with Medicare should report the
appropriate Evaluation and Management Service codes for the setting and level of care.
For outpatient encounters, the new or established Office or Other Outpatient codes
(99201-99215) should be reported. In the inpatient setting, report either initial inpatient
care codes (99221-99223) or subsequent inpatient codes (99231-99233).
The new policy means that more than one initial inpatient code may be reported for an individual
patient. Medicare recently announced that the “admitting” physician should append
HCPCS modifier A1 to the initial inpatient code. This modifier will distinguish that service
from those of specialists who also may be reporting the initial inpatient care code.
Subsequent visits should be reported using codes 99231-99233.
The elimination of payment for consultation services will result in a 6 percent increase in
payment for Office and Other Outpatient services and a 2 percent increase for Initial Inpatient
care codes. Increases will also be made for services with a 10- or 90-day global period
that have E/M services included in their value.
To date, other payers have not indicated they will eliminate the use of consultation
codes. Therefore, physicians should continue to report consultation codes (9924199245; 99251-99255) as appropriate to payers other than Medicare.
Additional information on Medicare’s consultation policy is available at:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf