I have a Medicare Secondary Payer (MSP) situation involving consult codes. The primary insurer still accepts the consult codes, but Medicare does not. How should I submit my MSP claim?

Answer:
If the primary payer for the service continues to recognize consultation codes, physicians and others billing for these services may either:

  • Submit an evaluation and management (E/M) code that is appropriate for the service to the primary payer and then report the amount actually paid by the primary payer, along with the same E/M code, to Medicare for determination of whether a payment is due
  • Submit a claim to the primary payer using a consultation code that is appropriate for the service and then report the amount actually paid by the primary payer, along with an E/M code that is appropriate for the service, to Medicare for determination of whether a payment is due

Resource: CMS MLN Matters article MM6740 (PDF, 133 KB), "Revisions to Consultation Services Payment Policy"

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