UnitedHealthcare to Discontinue Coverage of Consultations

March 4th, 2019 - Wyn Staheli, Director of Research
Categories:   CPT® Coding   HCPCS Coding   Billing  
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In United Healthcare's March provider bulletin, they announced that they will be phasing out coverage of consultation services (99241-99255). Beginning on June 1, 2019, they will begin by eliminating coverage for contracted providers with "contracted rates determined on a stated year 2010 or later." After this initial phase in period, it will then affect all healthcare providers as of October 1, 2019.

Tip: If you are unsure which implementation date applies to you, check your contract or contact the Provider Relations department and ask them.

The notice did say though that consultation services may be covered in conjunction with preventive care services such as lactation counseling. Also, telehealth/telemedicine codes "G0406G0408, G0425G0427, G0508 and G0509 will be payable pursuant to that policy, the participation agreement and the member’s benefit plan."

Once again, it seems that private payers tend to follow Medicare because Medicare stopped covering these services in 2010. Regardless of whether or not you are enrolled as a Medicare provider, it is important to be aware of Medicare coverage policies.

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