I have primary payment for a consultation service. My software does not allow me to change the procedure code to an E/M code that Medicare will accept. Since Medicare no longer accepts consultation codes, can I bill the patient the co-pay from the primary insurance and not submit a claim to Medicare?

Answer
Section 1848(g)(4) of the Social Security Act requires that you submit claims for all your Medicare patients for services rendered on or after September 1, 1990. This includes Medicare Secondary Payer claims. Although Medicare no longer accepts consultation codes, Change Request (CR) 6740 instructs providers on how to submit claims to Medicare for these services. Please contact your software company regarding any updates or changes that need to be made.

Resource

  • CMS MLN Matters article MM6740 (PDF, 133 KB)

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