UnitedHealthcare to Eliminate Consultation Codes

UnitedHealthcare (UHC) announced in the March issue of its Provider Network Bulletin that it will discontinue payment for consultation codes (CPT 99241–99255) later this year. Implementation of the policy will occur in two phases. On June 1, 2019, UHC will eliminate the consultation codes for practices with contracted rates based on a stated year 2010 or later Medicare fee schedule. As of Oct. 1, 2019, UHC will completely eliminate the consultation codes for all practices.

Previous Delayed Policies
UHC proposed similar policies in 2017 and 2018. In both cases, the payer subsequently delayed the policy after meeting with strong opposition from the ACR and other provider organizations. UHC’s stated goal was to bring its policy into alignment with Medicare, but stakeholders quickly pointed out that when the CMS eliminated consultation codes in 2010, it offset the cut by increasing the value of the codes for new and established patient visits. This argument was the main reason UHC delayed the policy, because some practices’ contracted fee schedules are still based on rates from 2009 or earlier. Before moving forward with implementation later this year, UHC will make an effort to ensure all practices’ contracted rates are based on a stated year 2010 or later Medicare fee schedule. Members are encouraged to review their contracts with UHC and make the best decision for their individual practice.

The ACR’s Response
The ACR is very concerned about the impact of this change on rheumatology practices, particularly in the current climate of proposed Medicare changes to E/M codes. The ACR’s Insurance Subcommittee is reaching out to UHC to oppose elimination of these codes and advocate for appropriate recognition and compensation of rheumatologists’ expertise and training.

If you have questions regarding this policy or other insurance coverage concerns, contact practice@rheumatology.org.