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Jurisdiction 11 Part B
Can a specialist/surgeon refer a patient to his family physician for a pre-operative surgical clearance physical (the patient is established and known to the family physician)?

Answer:
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.'

Yes, as long as the three elements of the consultation are met. The CMS Claims Processing Manual states that "pre-operative consultations are payable for new or established patients performed by any physician at the request of a surgeon, as long as all of the requirements for billing the consultation codes are met." The entire section on consultations (CPT codes 99241 through 99255) is available on the CMS website.

Resources:

 

last updated on 04/11/2013
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