As a reminder, effective August 1, 2018, Independence will update its reimbursement position on the Current Procedural Terminology (CPT?) codes used to report consultation services provided to Independence?s Medicare Advantage HMO and PPO members.
Based on a review of the Centers for Medicare & Medicaid Services (CMS) standards, Independence has created Medicare Advantage policy #MA00.049: Consultation Services, which outlines its reimbursement position on CPT consultation codes. This new policy was posted as a Notification on May 3, 2018, and will go into effect August 1, 2018.
The policy states that Independence will align with CMS?s position of no longer recognizing the following CPT consultation codes as eligible for reimbursement:
● 99241 ● 99251
● 99242 ● 99252
● 99243 ● 99253
● 99244 ● 99254
● 99245 ● 99255
When rendering services to Independence Medicare Advantage HMO and PPO members, all providers should report the appropriate level of evaluation and management (E&M) service in lieu of consultation codes.
Affected policies
This change to our reimbursement position for CPT consultation codes used to report consultation services also affects our Medicare Advantage policies on preoperative anesthesia consultations and Modifier 25 as outlined below.
Changes to the following Medicare Advantage policies, which were posted as Notifications on May 3, 2018, will go into effect August 1, 2018:
- #MA01.002: Preoperative Consultations Performed by Providers in Anesthesia Specialties: This policy will be archived, and anesthesia providers should report the CPT codes that represent the most appropriate level of E&M service.
- #MA03.003d: Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service: The following CPT codes will be removed from this policy and will no longer be eligible for reimbursement:
—? 99241, 99242, 99243, 99244, and 99245
More information
To view the Notifications for these policies, visit our Medical Policy Portal and select Accept and Go to Medical Policy Online. Then select Medicare Advantage under Active Notifications.
For questions about this policy, please review our Reimbursement position for consultation codes: Frequently Asked Questions (FAQ), which can also be found on Independence NaviNet? Plan Central in the Frequently Asked Questions section under Administrative Tools & Resources. Note: The FAQ will be updated as more information becomes available.
If you still have questions after reviewing the FAQ, email us at consultcodes@ibx.com. Be sure to include your name, contact number, and provider ID number in your email.
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