March 05, 2019
Area(s) of Interest: Payor Issues and Reimbursement Practice Management
UnitedHealthcare (UHC) has announced that it will no longer reimburse consultation services for commercial product lines. Consultation services previously represented by CPT codes 99241-99245 and 99251-99255 will need to be billed utilizing the appropriate evaluation and management (E/M) procedure code that describes the office visit, hospital care, nursing facility care, home service or domiciliary/rest home care.
While UHC had first announced this Consultation Services Policy change in 2017, the payor had delayed implementation after the California Medical Association (CMA), in conjunction with a number of other state medical societies, expressed serious concerns regarding the new policy.
According to UHC, the new policy is intended to conform with the Centers for Medicare and Medicaid Services (CMS), which ceased reimbursement of consultation services CPT codes in January 2010. At that time, CMS increased the Relative Value Units (RVUs) for E/M codes to offset this shift in its reimbursement methodology. For this reason, UHC encourages providers who are on an older fee schedule to modernize their fee schedules to bring them into alignment with CMS’s current RVU methodology, since the older fee schedule reimbursement does not appropriately align with current RVU structure for E/M services and many other procedure codes.
UHC will implement the consultation services policy change in two stages.
- For dates of service starting June 1, 2019, UHC will no longer reimburse CPT codes 99241-99255 for providers on a 2010 and newer fee schedule.
- For date of service starting Oct. 1, 2019, UHC will no longer reimburse CPT codes 99241-99255 for all fee schedules.
Providers with questions, or who would like to move to a more current fee schedule, can contact UnitedHealth Network Management or their assigned UHC Physician Advocate.