Medicare Payment for Consultation Codes to be Eliminated by CMS Proposed Rule


CMS, in its CY 2010 Proposed Physician Fee Schedule (PFS), has proposed

to eliminate billing codes for consultation services in most situations. The rule

would allow consultation codes in the context of initial visits for telehealth

services, but any other services that are currently billed as consultation codes

would have to be billed as new or established office visits, initial hospital visits,

or initial nursing facility visits. CMS proposes to implement the rule in a budget

neutral manner by increasing the relative value units (RVUs) associated with

new and established office visits, and with initial facility visits for hospitals and

nursing homes. The elimination of consultation codes would effectively

eliminate the reimbursement advantage for physician specialists providing

consultation services, which have historically been paid at a higher rate than

new and established office visits, initial hospital visits, or initial facility visits.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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