Does Medicare pay for CPT code 99245?

Does Medicare pay for CPT code 99245?

Medicare no longer pays for the CPT consultation codes (ranges 99241-99245 and 99251-99255). Instead, you should code a patient evaluation and management (E&M) visit with E&M codes that represent where the visit occurs and that identify the complexity of the service performed.

What does code 99245 mean?

CPT® Code 99245 – New or Established Patient Office or Other Outpatient Consultation Services – Codify by AAPC. CPT. Evaluation and Management Services. Consultation Services. Office or Other Outpatient Consultation Services.

Is 99245 a valid CPT code?

Outpatient consultations (99241—99245) and inpatient consultations (99251—99255) are still active CPT® codes, and depending on where you are in the country, are recognized by a payer two, or many payers.

How many minutes is 99245?


Outpatient – New
Codes 99201 99205
Outpatient – Consultation
Codes 99241 99245
Times 15 min. 80 min.

How do I bill Medicare inpatient consult?

Inpatient consultations should be reported using the Initial Hospital Care code (99221-99223) for the initial evaluation, and a Subsequent Hospital Care code (99231-99233) for subsequent visits.

How do I bill inpatient consult for Medicare?

Does Medicare pay for consultation codes?

The Centers for Medicare & Medicaid Services (CMS) has eliminated the coverage of consultation codes as of January 1, 2010. Understanding coding policy is confusing enough; however, now there is a mix of coding policy and coverage policy that one is forced to distinguish.

How do you document time spent with a patient?

You still must spend more than 50 percent of your time on counseling or coordination. To properly document your time, use statements like these: “I spent 30 minutes face-to-face with the patient, over half in discussion of the diagnosis and the importance of compliance with the treatment plan.”

Does Medicare accept inpatient consult codes?

Medicare does not accept claims for either outpatient (99241-99245) or inpatient (99251-99255) consultations, and instead requires that services be billed with the most appropriate (non-consultation) E/M code.

Does Medicare pay for consult codes?

Pursuant to 42 CFR § 411.351 and section 15506 of the Medicare Carriers Manual, Medicare allows reimbursement for consultations if (1) a physician requests the consultation, (2) the request and need for the consultation are documented in the patient’s medical record, and (3) the consultant furnishes a written report to …

Can you bill consult codes to Medicare?

Medicare has eliminated consultation codes. Now you will have to bill using regular office visit codes and hospital admit codes.