CPT 99241 - 99245 consultation update

Consultation Code Update - UnitedHealthcare


For UnitedHealthcare commercial plans, there will be no change in reimbursement for CPT codes 99241-99245 and 99251-99255 at this time. Physicians may continue to submit claims for theseservices, and will be reimbursed according to UnitedHealthcare payment policies.For UnitedHealthcare Medicare Solutions, including SecureHorizons®, AARP®MedicareComplete®, Evercare®, and AmeriChoice® Medicare Advantage benefit plans, theseplans will follow CMS regulations and implement the change, effective January 1, 2010. Thechange also includes the revalued relative-value units (RVUs) for E&M CPT codes and a newcoding edit, consistent with CMS, to deny the CPT consult code as a non-payable service.



For AmeriChoice Medicaid health plans, in state Medicaid plans that follow Medicare rules fortheir fee schedules, AmeriChoice will be aligning with CMS and implement the change, effectiveJanuary 1, 2010. For all other Medicaid states, AmeriChoice will follow the UnitedHealthcarecommercial position and continue to pay for the consult codes, until directed by each state topursue other strategies.

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