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Blackhorse Posted Sun 31st of December, 2017 19:02:29 PM
Please also let me know where you found the information.
SuperCoder Answered Tue 02nd of January, 2018 07:09:27 AM

Hi,

Please refer to the below link for the answer to query :

https://www.ismanet.org/pdf/membership/ConsultationCodeCoverage.pdf

Thanks

Hope this helps!

 

Blackhorse Posted Tue 02nd of January, 2018 11:46:41 AM
Thanks. What about those big medical insurance companies such as Unitedhealthcare, Blue Shield, Health Net, Molina, Blue Card. I live in California and nor sure if the above insurance allow consultation codes.
Blackhorse Posted Tue 02nd of January, 2018 13:25:18 PM
The link attached is for Indiana State only, or it applies to California also. Thank you.
SuperCoder Answered Wed 03rd of January, 2018 07:23:48 AM

 

>Hi,

>BCBS and UHC

>But, anyone who follows CMS guidelines will NOT accept the consults.

>While those CPT codes remain on the books and will continue to be paid by private insurers, doctors who provide consults for Medicare patients will have to bill for those services using initial or subsequent visit codes. 

>Also, UnitedHealthcare Community Plan will not reimburse consultation codes 99241 – 99245 or 99251-99255 for Medicare members.

 

Blackhorse Posted Wed 03rd of January, 2018 12:02:39 PM
I don't understand your answers. Please list all the major insurance who pays for consultation codes.
Blackhorse Posted Wed 03rd of January, 2018 12:09:45 PM
Please also list the insurance that don't pay for consultation codes such as Medicare. Appreciate it.
SuperCoder Answered Thu 04th of January, 2018 08:08:20 AM

Hi,

Our team is working on it and will get back to you soon.

SuperCoder Answered Fri 05th of January, 2018 02:44:06 AM

Hi,

 

 

Hi,

Commercial payers still allow consult codes, both inpatient and outpatient...Blue Cross of LA, Humana, Aetna, Humana, United Healthcare, Coventry. The only payers I'm aware of that do not accept them are Medicare, Medicaid, Tricare (the government-related payers).

Also, providers should verify specifically whether or not the plans will recognize the consultation codes.

UnitedHealthc are, for example has communicated to members that it has implemented the CMS regulations for its UnitedHealthcare Medicare Solutions, including SecureHorizons®, AARP® MedicareComplete®, Evercare®, and AmeriChoice® Medicare Advantage benefit plans, but says it will continue to reimburse commercial plans for CPT® codes 99241-99245 and 99251-99255 at this time.

Hope this answers all your questions.

 

Blackhorse Posted Fri 12th of January, 2018 12:04:48 PM
How about Health Net? Do they pay for consultation codes?
Blackhorse Posted Fri 12th of January, 2018 12:18:40 PM
My senior coder wants to see documentation from Aetna that says they will pay for consultation, can you provide me the documentation.
SuperCoder Answered Mon 15th of January, 2018 06:28:45 AM

Hi,

The relevant information about Health Net can be found in the link below :

http://www.cmanet.org/files/pdf/misc/health-net-guidance.pdf

Thanks

 

Blackhorse Posted Mon 15th of January, 2018 11:42:28 AM
What about the documentation regarding Aetna's consultation policy? Thank you.
SuperCoder Answered Tue 16th of January, 2018 07:13:39 AM

Hi,

Atena considers consult codes as active and pays for consult codes according to Atena agreement, for members who are covered under commercial benefit plans and Medicare Advantage plans. However, we will no longer recognize or pay for consult codes for members covered under our Medicare Open SM Plan, a Private Fee-for-Service plan, or for claims from nonparticipating providers filing Medicare Advantage claims.

Additionally, there is very limited information available for California. Hence, you need to request the state payer (Atena) regarding reimbursement of consult codes as this is payer and state specific.

 

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