United Healthcare Plans to Discontinue Payment for Consultation Services


Citing alignment with a policy implemented by the Centers for Medicare and Medicaid Services (CMS), and in response to misuse of consultation service codes, UnitedHealthcare (UHC) has announced that it will no longer reimburse consultation services for commercial product lines effective October 1, 2017. Consultation services previously represented by CPT codes 99241-99245 and 99251-99255 will now 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.

CPMA has joined with other stakeholders in recommending that UHC address concerns with individual doctors directly rather than implementing such a broad policy that penalizes providers who bill these codes correctly.

(Source: CMANet [8/4/2017])