Cigna recently announced that they 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. Impacted CPT codes are 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254 and 99255.
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Cigna will become the second payer to discontinue payment for consultation services in 2019. UnitedHealthcare announced earlier this year that they would 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, they will eliminate the consultation codes for all practices.
The ACR is very concerned about the impact of these changes on rheumatology practices. ACR’s Insurance Subcommittee is engaging payers to express opposition to the elimination of these codes and to advocate for appropriate recognition and compensation of rheumatologists’ expertise and training.
If you have questions regarding this policy or other insurance coverage concerns, please contact [email protected].