Medicare Eliminates Consultation Codes
Consultation Codes are being eliminated from the Medicare program, except for Telehealth services, effective January 1, 2010. Instead, initial and subsequent visit codes will be used in the hospital and nursing facility. New and established patient codes will be used in the office/clinic setting. The RVUs are being increased for the initial visit/new patient codes and subsequent visit/established patient visit codes in all settings.
- Consultation codes, in any setting, were previously not eligible for shared/split visit billing.
- In the hospital, an initial and subsequent hospital visit may be billed as a shared visit under the physician's NPI, with reimbursement at 100%, if all the requirements for a shared visit are met.
- In the office, only established patient visits are eligible for shared visit billing. This rule has not changed. Of course, the incident-to rule still applies in the office setting as well.
CPT© 2010 will continue to list the Consultation Codes. The private payers will continue to utilize the Consultation codes. AAPA will begin to query private payers to obtain information on their long-term plan for the use of consultation codes. This new rule applies to Medicare consultations only.
The new rule was published in the Federal Register November 25, 2009.
The CMS Transmittal for this new rule was released on December 14, 2009, and the associated MLN Matters article (Medicare Learning Network) was published December 27, 2009. The implementation date for the new rule is January 4, 2010.
