Consultation Services Policy
This policy addresses the information UnitedHealthcare requires to be submitted with reimbursable consultation services codes and how services rendered at the request of another physician or appropriate source may be reported in lieu of CPT(®) consultation services codes 99241-99245 and 99251-99255.
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Click to Download: Consultation Services Policy
Questions and Answers
Q: Who are considered “appropriate sources” for requesting a telehealth consultation service?
A: CMS states requests for telehealth consultation services must come from an appropriate source. For the purpose of this policy, “appropriate source” includes but is not limited to a physician, physician assistant, nurse practitioner, psychologist, and social worker.
Q: If a telehealth services consultation code is not appropriate to report, or a claim for a telehealth consultation code has been denied because an appropriate referring source has not been identified on the claim, how should the evaluation and management service be reported?
A: A claim for telehealth services that does not meet the criteria as a consultation may be submitted (or resubmitted) with an appropriate non-consultation telehealth services code and it will be considered for reimbursement.
Q: What happens after June 1, 2019 or October 1, 2019 if the care provider’s claim for service is denied?
A: When consultation services codes 99241-99245 and/or 99251-99255 are denied for dates of service on or after June 1, 2019 or October 1, 2019 (according to the providers payment methodology), care providers should submit anappropriate E/M service in alignment with either the 1995 or 1997 E/M Coding Guidelines.
Q: Which consultation services codes will continue to be reimbursable?
A: Telehealth Consultation services represented by procedure codes G0406-G0408, G0508, G0509 and G0425-G0427 as well as Interprofessional consultations represented by 99451-99452, 99446-99449, will still be eligible for reimbursement if reported with the referring entity’s name and/or National Provider Identifier (NPI) number. This information should be reported in field 17 or 17b on the CMS 1500 form or its electronic equivalent.