Wiki Medicare and ER consults

[robin@tnoculoplastics.com]

Our physicians are on call at our local hospitals and they are under the impression that Medicare (straight not advantage) will not accept ER codes ( 99281 to 99285). I have tried to look up that information and can not find anything. If they are not inpatient, would you not be able to bill the ER consult codes?
thanks!!

 

[Maddygtru20]

EFF 01/01/2023 THOSE ARE THE CODES TO USE INSTEAD OF CONSULTS 99242-99245 USE THIS LINK AND ENTER THE CPT 99242 JUST TO CHECK AND YOU WILL FIND THAT CODE IS NOT ON THE FEE SCHEDULE https://www.cms.gov/medicare/physician-fee-schedule/search?Y=0&T=4&HT=0&CT=3&H1=99281&M=5

 

[thomas7331]

Our physicians are on call at our local hospitals and they are under the impression that Medicare (straight not advantage) will not accept ER codes ( 99281 to 99285). I have tried to look up that information and can not find anything. If they are not inpatient, would you not be able to bill the ER consult codes?
thanks!!

Medicare does accept emergency E/M codes. See section 30.6.11 - Emergency Department Visits - in chapter 12 of the Medicare Claims Processing Manual, linked here:

https://www.cms.gov/sites/default/files/2020-05/clm104c12_0.pdf

Any physician seeing a patient registered in the emergency department may use emergency department visit codes (for services matching the code description). It is not required that the physician be assigned to the emergency department.