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Consultation visits codes

Selina Posted Thu 31st of October, 2019 11:49:47 AM
Hello, Which payers are currently allowing consultation codes? Is anyone NOT allowing besides Medicare, Aetna, Cigna, United? Thank you!
SuperCoder Answered Fri 01st of November, 2019 07:31:22 AM

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.

 

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