Announcement Detail

As you may be aware, effective January 1, 2010, the Centers for Medicare and Medicaid Services (CMS) will be eliminating the use of Evaluation and Management (E&M) Consultation CPT codes ( 99241-99255) for its Medicare providers and requiring them to bill the most appropriate office visit or hospital inpatient CPT codes (99201-99215, 99221-99239).

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. 

For UnitedHealthcare Medicare Solutions, including SecureHorizons®, AARP® MedicareComplete®, Evercare®, and AmeriChoice® Medicare Advantage benefit plans, these plans will follow CMS regulations and implement the change, effective January 1, 2010. The change also includes the revalued relative-value units (RVUs) for E&M CPT codes and a new coding edit, consistent with CMS, to deny the CPT consult code as a non-covered service.

For AmeriChoice Medicaid plans that follow Medicare rules for their fee schedules, AmeriChoice will be aligning with CMS rules and implement the change effective January 1, 2010.  For all other Medicaid states, AmeriChoice will follow the UnitedHealthcare commercial position and continue to pay for the consult codes, until directed otherwise by a state to pursue other strategies.

UnitedHealthcare will be releasing a news notice and an article in the January Network Bulletin, after the New Year.

If you have questions regarding how this will affect your physicians please contact Mia Rosenberg, Director, Advocate Consistency at mia_rosenber g@uhc.com or 215-982-7805.