Another commercial insurance payer has announced that they will no longer be paying for consult codes (99241-99245 and 99251-99255). Cigna announced that as of October 1, 2019, they will deny claims submitted with those codes.

While Medicare eliminated consult codes in 2011, it has taken a while for commercial payers to follow suit. However, it seems that they are finally moving in that direction. United Healthcare made a similar announcement earlier this year and it is likely that we will see more payers make similar announcements next year.

Be sure that your billing team is aware of these changes to avoid unnecessary denials and delayed payment. You will need to submit an appropriate new or established E/M code in place of the consult codes that have been eliminated. Review the CPT codes and guidelines to ensure that you are selecting the appropriate level, as there may not necessarily a one to one crosswalk due to differences in the documentation and service requirements.

For more information, contact us.