The WVSMA has been requesting information from both commercial and governmental payors as to how they plan to handle the proposed change in the consultation policy. This information was originally written December 1, 2009 and updated for this issue of the Wesgram Online.
Please keep the WVSMA informed of any concerns that you are having in your practice regarding the new consult policy or other issues.
Medicare
Medicare has eliminated all consultation CPT codes (both inpatient and office/outpatient codes) for various places of services except for teleconference codes. Work RVUs will increase for new and established office visits, initial hospital visits and initial nursing facility visits. Physicians must now bill an appropriate E/M code based on the complexity of the visit and where the visit occurs.
Effective January 1, 2010, the Centers for Medicare and Medicaid Services (CMS) eliminated the use of Evaluation and Management (E&M) Consultation CPT codes ( 99241-99255) for its Medicare providers and began requiring them to bill the most appropriate office visit or hospital inpatient CPT codes (99201-99215,99221-99239).
Medicaid
Medicaid (Unisys) is following the CMS guidelines. Effective 1/1/10, WV Medicaid adopted the Medicare Billing Policy and terminated all consultation E&M codes as of 12/31/09. Services should be billed using the appropriate E&M service codes. For questions, you may contact Unisys Provider Relations at 1-888-483-0793.
PEIA
PEIA had originally announced plans to continue to accept the consult codes and reimburse them with the Evaluation and Management allowances; however, as of the end of December, a change was made. If a provider bills a consult, PEIA will deny it with a remark that asks the provider to bill with the appropriate E & M code. Providers were sent a letter informing them of the change.
Aetna
As of now, Aetna is not making any changes. If Aetna decides to make a change they will first send a letter that gives 90 days notice.
Aetna will be following their current fee schedule. The plan does not change the fee schedule in January; instead they wait until September or October to change. The Aetna fee schedule will remain at 130% of 2009 Medicare.
Blue Cross Blue Shield
As of this date, Mountain State Blue Cross Blue Shield has stated that the plan will not be making any changes in their billing and reimbursement policies regarding consults.
Carelink
Carelink states that the plan will follow CMS guidelines with the consult codes; however as of January 8, 2010, they were still paying the consult codes. The plan representative states that they have no billing changes. Carelink adjusts reimbursement rates when Medicare updates their physician fee schedule.
CIGNA
CIGNA states that since CMS has not eliminated the consultation codes and the 2010 version of RBRVS still contains Relative Value Units for these codes, the plan will still recognize these codes for billing and reimbursement on January 1, 2010.
CIGNA also plans to continue to study the CMS change in conversion factor and will not institute the 21.2% reduction on January 1, 2010. CIGNA will provide 90 day advance notice to health care professionals on any action taken after a study of the components of the CMS RBRVS 2010 rule.
Health Plan of the Upper Ohio Valley
The WVSMA was originally advised that, per the Director of Claims for the Health Plan of the Upper Ohio Valley, the plan would be following Medicare's new rules as of January, 2010. This changed early in January when we were advised that the Health Plan would not be implementing this policy until February 2010 or after that date, per Health Plan's vice president of operations.
Humana
Humana has announced that, beginning January 1, 2010, for Medicare Advantage lines of business these CPT codes (99241-99255) are not acceptable. The plan now will require the most appropriate office visit or hospital inpatient CPT Codes (99201-99215, 99241-99239)
For non-Medicare Advantage lines of business the Humana systems will accept either set of codes.
United HealthCare
For UnitedHealthcare commercial plans, there will be no change in reimbursement for CPT codes 99241-99245 and 99251-99255 at this time. Physicians may continue to submit claims for these services, and will be reimbursed according to UnitedHealthcare payment policies.
|
