Consultation services (99241–99245, 99251–99255) have been excluded from payment under the Medicare program since 2010. Some health plans and other payers have also adopted a policy of not allowing payment for services reported with consultation codes. These plans require that physicians and other qualified health care professionals instead report the applicable evaluation and management (E/M) code for the site of service (eg, office or hospital visit).

Some health plans do still allow payment for the consultation codes when appropriately reported. This matters because there are differences in the relative value units (RVUs) assigned to consultations versus those assigned to alternatively reported E/M services. The Table has examples of the difference in payment. Note that comparisons of consultations and other services are not one-to-one, as requirements for code selection are different for each category of E/M service. Also, only new patient office E/M codes (99202–99205) are...

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