consult code payment

Is there a list of what insurance companies that do not accept or pay for consult codes?

re: consult code payment

Almost no health insurance company except Medicare will pay them in my experience. In fact none come to mind.

re: consult code payment

I bill consutation codes 99241-99245 and 99251-99255 to everyone with the exception of Medicare and Cigna and get paid.

re: consult code payment

Medicare DOES NOT pay for consults. They stopped accepting consult codes effective 1/1/2010.

Also, Medicaid programs, Tricare, Work Comp, and any Medicare supplements DO NOT accept them per CMS decision of 1/1/2010.

Some commercial plans still accepts them, such as BCBS and UHC.

You would need to check with the insurance companies themselves to be sure. But, anyone who follows CMS guidelines will NOT accept the consults.

Hope this helps!

re: consult code payment

[Medicare DOES NOT pay for consults. They stopped accepting consult codes effective 1/1/2010.

Also, Medicaid programs, Tricare, Work Comp, and any Medicare supplements DO NOT accept them per CMS decision of 1/1/2010.

Some commercial plans still accepts them, such as BCBS and UHC.

You would need to check with the insurance companies themselves to be sure. But, anyone who follows CMS guidelines will NOT accept the consults.

Hope this helps!]

You are right, I went back and checked our claims with consult codes that got paid by Medicare and it was a mistake, they recouped payment. It gets confusing when they pay initially!

We do eventually get worker's comp and auto liability policies to pay for them via arbitration/litigation sometimes, but they won't as general policy. We continue to bill them though.

re: consult code payment

What if you use codes 99354-99359? Are Prolonged Services accepted with all insurance carriers? Thanks

re: consult code payment

Thanks so much for the replies. I am aware of the Medicare rule on consults and as a rule we do not bill the consult codes for any of the "Medicare Advantage" companies which includes Keystone 65 select as well. I did think that perhaps there was a listing of what insurance companies flatly did NOT consider the consult codes for payment. We have been paid by Medicaid for consults. Cigna is also one that does not pay consult codes.
Thanks for the help everyone.

re: consult code payment

[Thanks so much for the replies. I am aware of the Medicare rule on consults and as a rule we do not bill the consult codes for any of the "Medicare Advantage" companies which includes Keystone 65 select as well. I did think that perhaps there was a listing of what insurance companies flatly did NOT consider the consult codes for payment. We have been paid by Medicaid for consults. Cigna is also one that does not pay consult codes.
Thanks for the help everyone.]

re: consult code payment

Cigna does pay for the consult code all insurance companies pay for the Consults 99241-99245 except for Medicare or the Medicare replacements.

re: consult code payment

It is not my experience that ALL insurances except medicare pay for consult codes 99241-99245. Our BCBS absolutely does not pay for them. I find more insurances do not pay than there are ones that do.

re: consult code payment

I would agree. Many insurance companies have followed Medicare's lead on consult payments.

re: consult code payment

This varies so much by region. When I present to groups, I ask if any payers recognize consult codes. Many have third parties that do. State Medicaid varies by state. Of course ffs Medicare doesn't and everyone tells me Medicare Advantage, no matter which insurance company, doesn't pay.

Don't assume the commercial carrier doesn't accept consults and just stop billing them to all. It leaves revenue on the table.