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Hi Selina,
Thanks for your question.
Medicare and payers following Medicare are not paying for consultation codes. There are some payers paying consultation codes in their commercial plans. Here is a provisional list to refer.
|
Payer |
Commercial Plan |
Medicare Advantage |
|
Advantage Health Plans |
Covered |
Not Covered |
|
Aetna |
Covered |
Not Covered |
|
Anthem |
Covered |
Not Covered |
|
Cigna |
Covered |
Not Covered |
|
Humana |
Covered |
Not Covered |
|
Indiana Health Network (IHN) |
Covered |
Not Covered |
|
Sagamore |
Covered |
Not Covered |
Please refer https://www.ismanet.org/pdf/membership/ConsultationCodeCoverage.pdf
Payers keep changing their guidelines. Hence there may be changes in the above list. So, we suggest you to please contact your payer’s representatives and ask them for written guidelines regarding payment of consultation codes before billing consultation.
Please feel free to write if you have any question.
Thanks.