American Gastroenterological Association - Advancing the Science and Practice of Gastroenterology

CPT Coding Change Updates

CMS Provides Guidance to Physicians on Consultation Codes
As announced in AGA eDigest on Dec. 17, CMS has eliminated consultation codes effective Jan. 1.

• Medicare has issued a transmittal regarding the consultation services payment policy. Read a summary of the most important issues addressed in the transmittal.
• A MedLearn article was released on Dec. 14 with an effective date of Jan. 1, 2010, entitled "Revisions to Consultation Services Payment Policy." It contains detailed information for providers on appropriate coding with the elimination of the consultation codes.
• Read the AGA policy blog for practical pointers.

AGA recommends that the guidance documents be reviewed, as it is important for physicians to ensure accurate coding in order to receive timely payment of claims.

UnitedHealthcare Provides Guidance on Elimination of CPT Codes
For UnitedHealthcare commercial plans, there will be no change in reimbursement for current procedural terminology (CPT) codes 99241-99245 and 99251-99255 at this time. Physicians may continue to submit claims for these services, and will be reimbursed according to UnitedHealthcare payment policies.

For UnitedHealthcare Medicare Solutions, including SecureHorizons^®, AARP^® MedicareComplete^®, Evercare^® and AmeriChoice^® Medicare Advantage benefit plans, these plans will follow CMS regulations and implement the change, effective Jan. 1, 2010. The change also includes the revalued relative value units for evaluation and management CPT codes and a new coding edit, consistent with CMS, to deny the CPT consult code as a non-covered service.

For AmeriChoice Medicaid plans that follow Medicare rules for their fee schedules, AmeriChoice will be aligning with CMS rules and implement the change effective Jan. 1, 2010. For all other Medicaid states, AmeriChoice will follow the UnitedHealthcare commercial position and continue to pay for the consult codes until directed otherwise by a state to pursue other strategies.

If you have questions regarding how this will affect your physicians, please contact Mia Rosenberg at mia_rosenberg@uhc.com or 215-982-7805.