Earlier this year, UnitedHealthcare announced and then delayed a policy change indicating that consultation codes would no longer be paid under its commercial health plans. Instead, physicians providing a consultation service would report other evaluation and management (E/M) codes based on the site of service where the consultation is provided (eg, office or other outpatient office visit). Telehealth consultations for critical care (G0508, G0509) and for inpatient and emergency department consultations (G0425–G0427, G0406–G0408) were not affected by the proposed policy change. At this time, there is potential for reversal of this decision. However, as with coding for too many services, other health plans are also varying in their payment policies for consultation services.

In this article, we will review Current Procedural Terminology (CPT®) instructions for consultation services and provide an overview of options for reporting to payers no longer accepting consultation codes...

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