UHC Indicates No Changes in Payment for Consultation Services

December 22, 2009

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There will be no change in reimbursement for consultation services from UnitedHealthcare (UHC) commercial plans—CPT codes 99241-99245 and 99251-99255—at this time. Physicians may continue to submit claims for these services, and will be reimbursed according to UHC payment policies.

For UnitedHealthcare Medicare Solutions—including SecureHorizons®, AARP® MedicareComplete®, Evercare®, and AmeriChoice®Medicare Advantage benefit plans—these plans will follow CMS regulations and implement the change, effective January 1, 2010. The change also includes the revalued relative-value units (RVUs) for evaluation and management (E/M) CPT codes and a new coding edit, consistent with CMS, to deny the CPT consult code as a non-covered service.

For AmeriChoice Medicaid plans that follow Medicare rules for their fee schedules, AmeriChoice will align with CMS rules and implement the change effective January 1, 2010. For all other Medicaid states, AmeriChoice will follow the UnitedHealthcare commercial position and continue to pay for the consult codes, until directed otherwise by a state to pursue other strategies.

UHC will release a news notice and an article in the January Network Bulletin after the first of the year; the AAN will provide a link to this update once it is released.