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  • > Top Headlines

    UHC Notice – Elimination of Consultation Reimbursement

    The June 2017 edition of the United Healthcare Bulletin includes notification that UHC will discontinue payment of CPT codes for consultation services (99241-99245 and 99251-99255). The change is effective October 1, 2017. A copy of the notice appears below. I wanted you to be aware in the event this change will impact your practice.

    In taking this action, UHC will become the first major carrier to stop paying for consultation codes. Recognizing the detrimental impact that this change will have on patient access to specialty care, the NCSOHNS and the North Carolina Medical Society, along with several other state medical and specialty societies, have signed on to a letter urging UHC to reconsider the policy change or, at the least, to delay implementation until providers have adequate time to properly prepare for the policy change.



    UnitedHealthcare Commercial Reimbursement Policies
    Revision to the Consultation Services Reimbursement Policy

    Effective for claims with dates of service on or after Oct. 1, 2017, UnitedHealthcare will reimburse the appropriate evaluation and management (E/M) procedure code which describes the office visit, hospital care, nursing facility care, home service or domiciliary/rest home care reported in lieu of a consultation services procedure code. This notification will be the first of several communications to clarify this change in reimbursement strategy supporting our commitment to the Triple Aim of improving health care services, health outcomes and overall cost of care.

    UnitedHealthcare will align with the Centers for Medicare & Medicaid Services (CMS) and no longer reimburse consultation services represented by CPT codes 99241-99245 and 99251-99255. At the time of the original CMS decision to no longer recognize these consultation services procedure codes, UnitedHealthcare began pursuit of data analysis and trending to better understand the use of consultation services codes as reported in the treatment of our commercial members. Similar to CMS’s findings, our extensive data analysis has revealed misuse of consultation services codes for this population.

    The current Relative Value Unit (RVU) assignments reflect numerous changes made during recent years to both E/M codes and other surgical services creating an overall budget neutral experience supporting this strategy as a more accurate reflection of services rendered.

    ICYMI: This Avoided Administrative Nightmare in Medicaid Brought to You by the NCMS
    Source: NC Medical Society

    So far, 2017 has been a successful year for our Medicaid advocacy work. Last month, the Division of Medical Assistance (DMA) abandoned its plan to activate “rendering provider service location edits” in NCTracks, another burdensome administrative requirement affecting all physicians, PAs, and individual providers.

    Teaming with the NC Medical Group Management Association (NCMGMA), the North Carolina Medical Society (NCMS) argued that complying with the edits would require countless hours of administrative work for medical practices statewide, risked another major disruption to the flow of claims and payments, and most importantly, offered absolutely no benefit to the Medicaid program, providers, or patients.

    After several months of persistent work by NCMS and NCMGMA, DMA officials eventually agreed to scrap the edits. “This was an incredibly important win to keep Medicaid practices running smoothly. We are pleased and grateful that DMA listened to reason and agreed to drop this requirement,” said Leah Paraschiv, Chair of NCMGMA’s Medicaid Committee.

    This comes quickly on the heels of the victorious effort to block the 1 percent rate cut, and serves as another example of how the NCMS works behind the scenes to protect your practice in Medicaid. We’ve got your back!