Consultation CPT code 99244

Level 4 Office Consult (99244)

Medicare wont cover Consult code hence use appropriate other E & M code., read below

The documentation for this encounter requires THREE out of THREE of the following :

1)  Comprehensive History
2)  Comprehensive Exam
3)  Moderate Complexity Medical Decision-Making

Or 60 minutes spent face-to-face with the patient if coding based on time.  The appropriate documentation must be included.

This is the most popular code used to bill for office consults.  Internists selected the 99244 code for 40% of these encounters in 2009.   To get an idea of the frequency of use of this code among sub-specialists, nephrologists used this level of care for a whopping 49% of consults performed in the office during that same year (which added up to 77,556 visits). The 99244 ranked 46th among the most frequently used CPT codes by all physicians in 2009.  The reimbursement for this level of care is approximately $168.00.  Usually the presenting problems are of moderate to high severity.

How ever Medicare will not cover this service in 2010. Check the other post in this website.

The CMS will pay a consultation fee when the service is provided by a physician at the request of the patient’s attending physician when:

• All of the criteria for the use of a consultation code are met;

• The consultation is followed by treatment;
• The consultation is requested by members of the same group practice;
• The documentation for consultations has been met (written request from an appropriate source and a written report furnished the requesting physician);
• Pre-operative consultation for a new or established patient performed by any physician at the request of the surgeon; and
• A surgeon requests that another physician participate in post-operative care (provided that the physician did not perform a pre-operative consultation).

Medicare Payment Rules for Consultation Services

Medicare no longer recognizes consultation CPT codes 99241-99245 and 99251-99255. This applies for both Medicare-primary and Medicare-secondary claims. Please Note: These codes are still valid CPT codes for 2010, and Blue Cross continues to accept these consultation codes. We have current allowable charges for these codes and any changes in allowable amounts or billing policies for these codes will be communicated to our providers with a 90-day notice. At this time, we do not anticipate any changes.

Per CMS, physicians and others must bill an appropriate Evaluation and Management code for the services previously paid using the consultation codes. If the primary payer for the service continues to recognize consultation codes, physicians and others billing for these services may either:

1. Bill the primary payer an Evaluation and Management code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with the same Evaluation and Management code, to Medicare for determination of whether a payment is due; or

2. Bill 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 Evaluation and Management code that is appropriate for the service, to Medicare for determination of whether a payment is due. 

Note: The first option may be easier from a billing and claims processing perspective. 


For more on this from the CMS, go to www.cms.hhs.gov/MLNMattersArticles/downloads/MM6740.pdf and www.cms.hhs.gov/MLNMattersArticles/downloads/SE1010.pdf.


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