United Healthcare to Revise Consultation Services Reimbursement Policy

Last Updated: Mar 7, 2019

doc-patient12-articleIn its March 2019 Network Bulletin, United Healthcare (UHC) announced that it is revising its reimbursement policy for consultation services. UHC says it will no longer reimburse CPT codes 99241-99255.

The insurer’s new policy aligns with the Centers for Medicare and Medicaid Services’ (CMS) current consultation services reimbursement policy. In 2010, CMS stopped reimbursing for consultation services CPT codes. Instead, CMS increased the Relative Value Units (RVUs) for evaluation and management (E/M) codes to offset this change.

UHC’s consultation services policy changes will be implemented in phases:

  • Effective for dates of service as of June 1, 2019, UHC will no longer reimburse CPT codes 99241-99255 when billed by any health care professional or medical practice with a participation agreement that includes contract rates determined on a stated year 2010 or later CMS RVU basis.
  • Effective for dates of service of Oct. 1, 2019, UHC will no longer reimburse CPT codes 99241-99255 when billed by any health care professional or medical practice.

Health care professionals and medical practices should instead bill consultation services in accordance with CMS’ E/M management guidelines.

Of note is that UHC will not be altering its Global Days Policy to reduce reimbursement for E/M codes submitted with modifiers 25 or 57. When UHC had first announced that it was planning to revise its consultation services policy, it had considered reducing E/M reimbursement.

Other key details concerning the new policy include:

  • UHC’s Telehealth and Telemedicine Policy will continue to apply.
  • Consultation services may still be reimbursed in accordance with the Preventive Care Services Coverage Determination Guideline.

Read UHC’s Network Bulletin article on the revised consultation services policy here. If you have specific questions on UHC’s new policy, you can contact your UHC Network representative.

Pennsylvania Medical Society (PAMED) members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.


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