UnitedHealthcare Revision to the Consultation Services Policy

March 2019 ~

UnitedHealthcare (UHC) has announced the revision of its Consultation Services Policy and will no longer reimburse CPT® codes 99241-99255.

CMS ceased reimbursement of consultation services CPT® codes in January 2010 and increased the Relative Value Units (RVUs) for E/M codes at that time to offset this shift in its reimbursement methodology. This change in reimbursement is intended to better align the insurer with CMS.

UHC plans to take a phased approach to implement this change as follows:

  1. Effective with dates of service of June 1, 2019, UHC will no longer reimburse CPT® codes 99241-99255 when billed by any health care professional or medical practice with a participation agreement that includes contract rates determined on a stated year 2010 or later CMS RVU basis.
  2. Effective with dates of service of October 1, 2019, UHC will no longer reimburse CPT® codes 99241-99255 when billed by any health care professional or medical practice.
  3. Health care professionals and medical practices should instead bill consultation services in accordance with current evaluation and management guidelines published by CMS.
  4. With respect to telehealth and telemedicine services, the Telehealth & Telemedicine Policy will continue to apply and HCPC codes G0406 – G0408, G0425 – G0427, G0508 and G0509 will be payable pursuant to that policy, the participation agreement and the member’s benefit plan.
  5. Consultation services may still be reimbursed when billed in accordance with the Preventive Care Services Coverage Determination Guideline for services such as lactation counseling.
  6. At this time, UHC will not be altering the Global Days Policy to apply a reduction to evaluation and management codes submitted with modifiers 25 or 57 as once announced with this Consultation Services policy change.

UHC is encouraging providers who are on an older fee schedule to modernize their fee schedules to bring them into alignment with CMS’s current Relative Value Unit methodology, since the older fee schedule reimbursement does not appropriately align with current RVU structure for E/M services and many other procedure codes.

According to the announcement, will partner with care providers on older fee schedules (2009 and prior) to facilitate a smooth transition.

 

CPT® is a registered trademark of the American Medical Association.

 

Source(s): UnitedHealthcare Network Bulletin March 2019;

 

 

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