Effective June 1, 2019, United Healthcare commercial plans will no longer reimburse providers who submit consultation codes (CPT 99241-99255), according to their April 2019 Network Bulletin. According to UHC, “This change aligns UnitedHealthcare with the Centers for Medicare and Medicaid Services (CMS).”
Providers who are requested to provide a consult for another provider should submit the appropriate Evaluation and Management (E/M) code in alignment with either the 1995 or 1197 CMS coding guidelines.
It shouldn’t really be much of a surprise that UHC is no longer going to be paying consult codes. Medicare stopped paying them back in 2010 and other payers have followed suit over the years. We will likely see the same announcement from other commercial payers in the near future, so make sure that your providers are aware of the changes and are properly coding the E/M codes for services requested by a referring provider.
For more details, check out the Coordinated Commercial Reimbursement Policy Announcement on page 26 of the April 2019 UHC Network Bulletin.