CMS consults billing policy

30 December 2009

Effective January 1, 2010, local Part B carriers and/or A/B MACs will no longer recognize American Medical Association (AMA) CPT consultation codes (ranges 99241-99245, and 99251-99255) for inpatient facility and office/outpatient settings where consultation codes were previously billed for services in various settings.

The AMA has strongly urged the Centers for Medicare and Medicaid Services (CMS) to delay for a year the implementation of its’ new consultations billing policy. Efforts have included multiple discussions between Rebecca Patchin, MD, the AMA’s chair of the board of trustees, and Department of Health and Human Services (DHHS) secretary Kathleen Sebelius. Unfortunately, the general counsel for the DHHS determined that CMS cannot delay a single section of the final Medicare Physician Fee Schedule Rule (MPFS). Rather, CMS must either delay or move forward with the implementation of the entire rule. Therefore, CMS made a decision to implement the entire MPFS rule, including the new consultations billing policy, on January 1. CMS has provided two educational pieces on the new policy, Transmittal #1875  and a Medicare Learning Network article . The AMA has requested that CMS clarify some of the policies raised in these documents and take additional educational steps to assist physicians with this new policy. We will keep MSV members posted on CMS’s efforts to further educate physicians on this new policy.