Cigna recently announced that it will discontinue payment for consultation codes later this year. As of Oct. 19, 2019, the payer will implement a new policy on evaluation and management (R30) that will deny claims billed with CPT codes for consultation services as not valid. Affected CPT codes include 99241, 99242, 99243, 99244,99245, 99251, 99252, 99253, 99254 and 99255.
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If Cigna moves forward with this policy, it will become the second payer to discontinue payment for consultation services in 2019. UnitedHealthcare announced earlier this year that it would also eliminate the consultation codes in two phases. On June 1, 2019, UHC discontinued payment for practices whose contracted rates are based on a stated year 2010 or later Medicare fee schedule. As of Oct. 1, 2019, it will eliminate the consultation codes for all practices. Medicare previously discontinued payment for consultation services in 2010.
The ACR is very concerned about the impact of these changes on rheumatology practices. The undervaluation of cognitive care is a serious issue. CMS recently acknowledged this by proposing an increase in reimbursement for many evaluation and management services in the CY 2020 Revisions to Payment Policies Under the Physician Fee Schedule proposed rule. Given that the current healthcare environment is moving toward a more appropriate valuation of cognitive care, it is most alarming that commercial payers would move to stop recognizing consultation services at this time.
The ACR’s Insurance Subcommittee sent a letter to Cigna expressing opposition to the elimination of these codes and advocating for appropriate recognition and compensation of rheumatologists’ expertise and training. During a follow-up call with Cigna in mid-September, ACR leaders asked that, at a minimum, Cigna delay plans to eliminate the consultation codes and instead follow CMS’ lead by updating the overall valuation of cognitive care services. The ACR will continue to fight these changes and will work alongside other cognitive care specialists to ensure that Cigna and other payers recognize and appropriately value these services.
If you have questions regarding this policy or other insurance coverage concerns, contact practice@rheumatology.org.