Wiki Consult codes

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Consultations have not been deleted. 99241-99255 are all still active CPT codes in 2021. Some payers, such as Medicare, will not pay for consultation codes; however, that is not new this year.

Hope that helps!

Leesa A. Israel, BA, CPC, CUC, CEMC, CPPM, CMBS, AAPC MACRA Proficient
Head of Publishing, Editorial & Technology
AAPC
 
Orthocoderpgu said:
In addition to that, consultations are almost never performed.
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Thanks for the reply. I work in an oncology office and we bill consultations ALL the time so I’m confused on the last part of your reply.
So the guidelines for both 99205 and 99245 will be the same or will our providers need to do different types of notes for Medicare and a different set of notes for other carriers who accept consult codes? That’s where the confusion is.
 
The new 2021 E/M changes 99205 but not 99245. CMS performed an audit of all consultations submitted for three years. 95% of the time the documentation did not support billing a consultation. CMS reached out to coders during that three year time frame letting coders know that the documentation did not support the consultation codes. There was no improvement in three years which is why CMS and now most private insurance companies don't pay for consultations any longer either. Unless the three "R"s of consultations are met, the code is not supported. If you are meeting the three 'R's you are in the 5% minority.
 
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