Two commercial payers have announced that they will stop reimbursing E/M services consultation codes CPT 99241-99255.
UnitedHealth announced in its newsletter March 2019, that it would match Medicare’s policy to stop recognizing and paying for consultations.
- “Effective with dates of service of June 1, 2019, UnitedHealthcare will no longer reimburse CPT codes 99241-99255 when billed by any health care professional or medical practice with a participation agreement that includes contract rates determined on a stated year 2010 or later CMS RVU basis.
- “Effective with dates of service of October 1, 2019, UnitedHealthcare will no longer reimburse CPT codes 99241-99255 when billed by any health care professional or medical practice.”
Source: “https://www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2019/network-bulletin/March-Revised-Network-Bulletin-2019.pdf“ – Page 20
Cigna’s announced in its July bulletin, that they will implement a new reimbursement policy for E/M (R30) and will stop recognizing and paying for consults as of October 19, 2019. - We will implement a new reimbursement policy, Evaluation and Management (R30), and deny claims billed with CPT consultation codes as not valid.
- The affected CPT codes are 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, and 99255.
- Claims can be resubmitted with the appropriate non-consultative E&M code that describes the service. Effective Date October 19, 2019 for claims processed on or after this date.
Source: “http://cdn.coverstand.com/33093/604394/8fd583c4d66b36ed5fc735ed382db9583f225c0b.7.pdf ” – Page 6
