Medicare Eliminates Consults: What the Academy is Doing For You

November 17, 2009

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When the Centers for Medicare & Medicaid Services (CMS) proposed eliminating consults in the summer of 2009, the Academy, along with other consultative specialties and the AMA, opposed the change. CMS finalized the change in the final rule of the Medicare Fee Schedule, which goes into effect January 1, 2010.

Only legislation can change this situation. The Academy is in talks with other consultative specialties about a legislative route, but acknowledges that getting legislation passed may be difficult due to the negative impact it would have on primary care.

CMS redistributed the money from the consultation codes to other E/M codes and is instructing physicians to instead use the new or established patient office and initial hospital visit codes. This table shows the change in values.

On November 16, the Academy held a phone meeting with CMS along with five other specialties to express specific implementation concerns about the elimination of consults. CMS did not provide feedback but committed to addressing the concerns in the guidance they are developing for physicians. CMS could not specify a date when more guidance would be available. The Academy is contacting private insurers about how they plan to handle consult codes.

Register for a December 8 webinar, "Medicare Eliminates Consults: What Neurologists Need to Know by January 1," to hear expert advice and ask questions.

Contact Gina at ggjorvad@aan.com if you have any questions.