Note: Consultation CPT codes are valid for Medicare claims only for dates of service on or before December 31, 2009. For consultative services provided on or after January 1, 2010, refer to the CMS MLN Matters article MM6740 (PDF, 133 KB), 'Revisions to Consultation Services Payment Policy.'
The inpatient consultation may be reported only once per consultant, per patient, per facility admission.
In the office or other outpatient setting, the consulting physician or qualified non-physician practitioner (NPP) shall use the appropriate office or other outpatient consultation (new or established patient) CPT codes (99241 through 99245) for the consultation service.
However, if the consultant assumes responsibility for management of a portion or all of the patient’s condition following his/her consultation, repeat consultation service codes are not reported. Instead, the appropriate evaluation and management (E/M) codes for the site of service (the subsequent hospital or nursing facility codes in the facility setting; established patient in the office or other outpatient setting) must be reported.
Reminder: Consultation services are distinguished from other E/M codes in that they are provided by a physician or other qualified NPP whose opinion or advice regarding the evaluation and/or management of a specific problem is requested. Consultations require the following ('3 Rs'):
- Request for an opinion on a specific problem documented by the treating physician
- Render and document the opinion by the consultant
- Report back to the requesting physician