As you are aware, the Centers for Medicare & Medicaid Services (CMS) eliminated payment for office/outpatient and inpatient consultation codes (Current Procedural Terminology [CPT®] codes 99241–99245 and 99251–99255) in the Medicare program effective January 1, 2010. To maintain budget neutrality, the work relative value units (RVUs) for the new and established office, initial hospital, and initial nursing facility visits were increased.

In response to the new Medicare policy, the American Academy of Pediatrics (AAP) appealed to major health plans to continue to provide benefits coverage and separate payment for consultations and not follow the Medicare policy. This letter urges non-Medicare payers to continue to recognize and pay for consultations for the following reasons:

Note that the preventive medicine visit codes (99381–99395), observation care codes (99217–99220), subsequent hospital care codes (99231–99233), and hospital discharge codes (99238, 99239) are not affected by...

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