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Peer to peer review

Rene Posted Wed 24th of April, 2019 15:37:03 PM
Is there a way for a provider to charge for a Peer to Peer discussion with an insurance physician or a gatekeeper physician that has never met the patient but is hired by a third party to explain why the treating physician ordered a procedure such as an MRI, CT, etc?
SuperCoder Answered Thu 25th of April, 2019 06:44:23 AM

Hi Rene,


Thanks for your question.


Though we have a HCPCS code H0038 (Self-help/peer services, per 15 minutes) for peer services but Medicare does not pay for this.


In case of other payers, you need to contact representatives of your insurance and ask them to provide their policy regarding the payment of the peer services.


Hope this helps. Please feel free to write if you have any question.



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