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UHC Notice Elimination of Consultation Reimbursement
The June 2017 edition of the United Healthcare Bulletin includes notification that UHC will discontinue payment of CPT codes for consultation services (99241-99245 and 99251-99255). The change is effective October 1, 2017. A copy of the notice appears below. I wanted you to be aware in the event this change will impact your practice.
In taking this action, UHC will become the first major carrier to stop paying for consultation codes. Recognizing the detrimental impact that this change will have on patient access to specialty care, the NCSOHNS and the North Carolina Medical Society, along with several other state medical and specialty societies, have signed on to a letter urging UHC to reconsider the policy change or, at the least, to delay implementation until providers have adequate time to properly prepare for the policy change.
UnitedHealthcare Commercial Reimbursement Policies
Revision to the Consultation Services Reimbursement Policy
Effective for claims with dates of service on or after Oct. 1, 2017, UnitedHealthcare will reimburse the appropriate evaluation and management (E/M) procedure code which describes the office visit, hospital care, nursing facility care, home service or domiciliary/rest home care reported in lieu of a consultation services procedure code. This notification will be the first of several communications to clarify this change in reimbursement strategy supporting our commitment to the Triple Aim of improving health care services, health outcomes and overall cost of care.
UnitedHealthcare will align with the Centers for Medicare & Medicaid Services (CMS) and no longer reimburse consultation services represented by CPT codes 99241-99245 and 99251-99255. At the time of the original CMS decision to no longer recognize these consultation services procedure codes, UnitedHealthcare began pursuit of data analysis and trending to better understand the use of consultation services codes as reported in the treatment of our commercial members. Similar to CMSs findings, our extensive data analysis has revealed misuse of consultation services codes for this population.
The current Relative Value Unit (RVU) assignments reflect numerous changes made during recent years to both E/M codes and other surgical services creating an overall budget neutral experience supporting this strategy as a more accurate reflection of services rendered.
NC Medicaid Announces Direct Enrollment of Mid-Level Providers
Take action now to ensure that your claims are not suspended or denied.
In accordance with new Federal regulations, claims for services will no longer be filed as "incident to" in NCTracks. All attending, rendering, ordering, prescribing or referring providers in NC Medicaid or NC Health Choice, including Physician Assistants (PAs), Nurse Practitioners (NPs), Certified Registered Nurse Anesthetists (CRNAs), and Certified Nurse Midwives (CNM), are encouraged to begin submitting enrollment applications now to NCTracks. This will ensure that your claims are not suspended on November 1, 2016 the effective date of this new rule. Visit the Provider Enrollment page.
For all claims submitted beginning November 1, the providers National Provider Identifier (NPI) will be required as a data element on the claim for programs listed in this May 2016 Special Bulletin. Any NPI entered on a claim will be validated, even if it is not required for that service/claim type. Limited exceptions to this new regulation include any Resident or Intern in a Graduate Dental and Medical Education program.