How Private Insurers Will Handle Consultation Codes

Medicare has announced it will eliminate consultation codes in 2010, but what about private insurers? See the grid below for more information.

Private Insurer Use of Consultation Codes

Insurer

Commercial plans 

Medicare Advantage plans 
Aetna Consult codes allowed Consult codes allowed, except for Medicare Open plan
Amerihealth Mercy Consult codes allowed Consult codes allowed
Blue Cross of Northeast PA Consult codes allowed  Consult codes allowed
Capital Blue Cross Consult codes allowed  Consult codes allowed
Cigna Consult codes allowed Consult codes allowed
Gateway Consult codes allowed Consult codes eliminated
Geisinger Consult codes allowed Consult codes eliminated for Geisinger Gold
Health America Consult codes allowed Consult codes eliminated
Highmark Consult codes allowed, except Freedom Blue PFFS and PPO Consult codes eliminated
Humana Consult codes allowed Consult codes eliminated
Independence Blue Cross Consult codes allowed Consult codes allowed
Medicaid Consult codes allowed Consult codes allowed
United Healthcare Consult codes allowed Consult codes eliminated
Unison Consult codes eliminated Consult codes eliminated
UPMC Consult codes allowed Consult codes eliminated

 

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Comments: 12


Humana said it will no longer accept consultation codes for its Medicare Advantage plans, but it will accept them for commercial plans.

PA Medical Society at 7/7/2010 3:07:44 PM


Do you have any information about Humana Gold/Choice Medicare Advantage coverage? Are they still accepting consultation codes?

anonymous at 7/6/2010 3:16:15 PM


Primesource has sent out a memo dated 02/23/10 stating. "Please note and share with staff that effective for DOS March 15, 2010 and after PrimeSource will nor longer pay for services submitted with codes 99241-99245 and 99251-99255. For DOS March 15, 2010 and after, please submit the E/M code that best describes the service performed." They further state, "We continue to model our reimbursement policies and fess on Medicare practices."

anonymous at 3/3/2010 9:56:44 AM


Consult codes are now being rejected by Auto Carriers.

michelle at 2/24/2010 3:33:35 PM


I do believe that Gateway Medicare Assured does not pay for consultations. They don't even give you a reason on the EOB. Also Are you sure Medicaid is still allowing consultations because it was my impression that they were one with CMS not covereing them.

anonymous at 2/11/2010 9:34:45 AM




anonymous at 2/1/2010 5:31:45 PM


We are updating the story above based on your feedback. Thank you everyone for your comments.

Pennsylvania Medical Society at 1/22/2010 3:29:37 PM


Re UPMC Commercial Plans: I have an email from provider rep on 12/22/2009 saying "This would not affect commercial claims: all codes would remain status quo."

elaine at 1/19/2010 11:17:07 AM


Per Geisinger Rep on 01/18/2010: As it stands, the Geisinger Gold PFFS plan will not be paying for consults since that plan must mirror CMS guidelines. All other plans are still reimbursing for consults until you would receive further notice from us. I hope that information is helpful.

Cheryl at 1/19/2010 7:53:56 AM


All I can say is "thank you" for helping to sort this out!

Kathy Malekovic at 1/15/2010 1:38:27 PM


Received UPMC email today, 1-11-2010, that their Medicare products only will drop consultation codes eff 1-1-10.

Karen at 1/11/2010 3:10:14 PM


UPMC Health Plan will also be eliminating consultation codes for UPMC for Life.

DAbraham at 12/28/2009 2:20:29 PM

Last Updated: 7/7/2010
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