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Jurisdiction 11 Part B
Can an emergency department visit be submitted if the physician consults with the ER physician over the phone but does not actually come to the emergency department?

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.'

No. This service may not be submitted to Medicare. If the physician comes to the emergency department, evaluates the patient and advises the ER physician, both physicians may submit the appropriate level of CPT codes 99281 through 99285.

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last updated on 06/03/2014
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