United Healthcare Delays Implementation of Consultation Services Policy Changes

United Healthcare (UHC) has announced that it will delay implementation of a policy that would have ended reimbursement for consultation services represented by CPT codes 99241-99245 and 99251-99255. The policy had been scheduled to take effect on Oct. 1, 2017.

A formal announcement of this policy delay was published in the UHC October 2017 Provider Network Bulletin.

Prior to the announcement, numerous medical societies had been urging UHC to reconsider the policy change. The Medical Society of New Jersey (MSNJ) was joined by 36 medical and specialty societies – including the Pennsylvania Medical Society – in sending a letter to UHC, urging the insurer to reconsider. The letter addressed concerns such as:

  • Care Coordination—Removal of consultation codes could result in a reduction in the usual coordination of care.
  • Education—The letter requested that UHC to provide the education necessary to properly code claims in order to avoid payment disruptions, in the event that it moves forward with the policy change.
  • Payment—The letter noted that, if UHC does not pay for Evaluation and Management (E&M) codes at an amount comparable to consultation codes, that it will result in financial burden to practices that provide consultations.
  • Audits—The medical societies asked that UHC provide guidance and assurance that specialists will not suddenly see an increase in audits due to a potential change in their billing practices.

Currently, there is no additional information on a possible future implementation date for the policy.

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