Medicare Proposes Ending Payment for Consultation Codes

The Proposed 2010 Medicare Physicians Fee Schedule Rule released by CMS last week included a bombshell hidden in amongst the 1128 pages: a proposal to discontinue reimbursement for the E/M consultation codes (CPT 99241-99255). These codes have been problematic for both physicians and insurers due to confusing and sometimes conflicting rules governing their appropriate usage. Over the years, Medicare has made numerous clarifications and code description changes to resolve the confusion. Now Medicare has decided to do away with the use of these codes altogether. Since consultation codes are reimbursed at significantly higher rates than regular office visit codes, CMS has proposed to increase rates for the remaining covered E/M codes to not penalize doctors while maintaining budget neutrality in their payments. If this proposal is implemented in November, it will become important that all physicians review their charges for E/M services (for both Medicare and commercial carriers) to ensure they are not undercharging Medicare for these visits and are in coding compliance if commercial insurers continue to pay for the consultation codes.