Consultations After Elimination of Payments for Evaluation and Management Consultation Codes

A consultation service provides expert opinion or advice at the request of another provider. The Centers for Medicare and Medicaid Services (CMS) eliminated reimbursement for the outpatient and inpatient consultation codes traditionally used to report these services (CPT 99241-99245 and 99251-99255, respectively), and private payers are likely to follow suit. CMS has instead mandated that these services are mapped to new or established visit codes for outpatients (99201-99205 or 99212-99215) and to initial or subsequent hospital services codes for inpatients (99221-99223 or 99231-99233). This article reviews appropriate medical consultation and provides specific guidance for the reporting of these services to CMS and other payers not reimbursing consultation codes.