Medicare Ends Reimbursement for Consultation Codes January 1, 2010!!!

A consultation is performed when one doctor requests another doctor perform a comprehensive evaluation of a patient.  Its usually asked of a specialist for complex cases.  The specialist will review all past records from the other doctor examine the patient order appropriate tests and then prepare a comprehensive written report back to the original doctor (if really complex I’ll call him directly myself to ensure he knows all the vital info I found). 

Medicare has announced plans to stop payment for this service beyond a simple office visit despite the significant extra time and effort required.  I understand the need to cut costs and reform but eliminating the minimal extra payment for the lengthly extra service delivered is not the right way to go. 

While the document is 1,669 Pages in length, Pages 162 – 206 contains commentary and CMS’ responses about the elimination of all consultation codes except for three telehealth consultation G codes beginning on January 1, 2010. Medicare fee-for-service will no longer accept or reimburse for any consultation codes for services rendered on or after January 1, 2010. Billing for consults will need to be billed using the most appropriate E&M code for office or inpatient, new or established visit code.

Please read the attached CMS Press Release. The full Federal Register text is contained in this document.

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