CMS to Redistribute Payment for Evaluation and Management Services Starting January 1

November 2, 2009

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The Centers for Medicare and Medicaid Services (CMS) has announced plans to stop paying for consultation codes and to redistribute those dollars to other evaluation and management (E/M) services as part of its 2010 Final Medicare Physician Fee Schedule (MPFS).

Beginning January 1, 2010, CMS will stop paying for all consultation codes (inpatient and office/outpatient codes for various places of services) on a budget-neutral basis by increasing work relative value units (RVUs) for new and established office visits (approximately six percent), increasing the work RVUs for initial hospital and initial nursing facility visits (approximately 0.3 percent).

The provision will eliminate the complexity associated with consultation services, since specialists will no longer need to be concerned with the documentation of the referring physician. Practitioners are being instructed to determine the appropriate visit code based solely on existing rules and guidelines for the use of these codes without any reference to the guidelines that have been employed for the use of the consultation codes. Time in excess of level 5 E/M codes should still be reported using an appropriate modifier.

It remains to be seen if private insurers will follow suit or continue to pay for consultation services. The Academy will offer further coding education and tools for members soon.