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BLUE REVIEWSM

for Providers

July 2024

Coding Update: Reimbursement Change for Consultation Services, Effective Sept. 1, 2024

Effective Sept. 1, 2024, we’re updating our Clinical Payment and Coding Policy for Evaluation and Management Coding (CPCP024).

Under this revised policy, we’ll no longer reimburse for outpatient or inpatient consultation services billed with Current Procedural Terminology (CPT®) codes 99242-99245 and 99252-99255. Consultation services should be reported with an appropriate office outpatient or inpatient evaluation and management code representing the location where the visit occurred and the level of complexity of the visit performed.

What You Need To Do
Refer to our Clinical Payment and Coding Policies page to review in detail the revised policy – Evaluation and Management Coding CPCP024.

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CPT copyright 2023 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA.

This is for informational and educational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider, nor is the information presented intended to replace or supersede any requirements set forth in your contract with Blue Cross and Blue Shield of Illinois. Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment.

This material is for educational purposes only and is not intended to be a definitive source for coding claims. Health care providers are instructed to submit claims using the most appropriate code(s) based upon the medical record documentation and coding guidelines and reference materials.

Any samples in this article are for illustrative and/or educational purposes only and should not be relied on in determining how a specific provider will be reimbursed. In the event of a conflict between the information in this article and your contract, your contract will control.