Beginning in October 2019, two major commercial payers, UnitedHealthcare and Cigna, discontinued payment for consultation services. The CPT codes affected include 99241–99245 and 99251–99255. The payers have instructed providers to instead bill the non-consultative evaluation and management (E/M) codes that best describe the services performed.
If the non-face-to-face service goes beyond the usual time a provider would spend on the service, providers may be able to use other codes to receive reimbursement for work conducted outside an office visit. CPT codes 99358 and 99359 allow providers to bill for time spent on non-face-to-face prolonged services, such as extensive chart review, on the same or different day as an office visit. Providers are encouraged to confirm coverage status of these codes with the individual payer.
Additional guidance on billing these codes can be found in “A Look at CPT Codes for Prolonged Services.” With additional questions, contact [email protected].
