Announcement Detail

A message from Aetna to ILMGMA Members:

Medicare will no longer pay for consultation codes

Effective January 1, 2010, the Centers for Medicare & Medicaid Services (CMS) removed the consultation codes from the Medicare Physician Fee Schedule (MPFS). The relative value units (RVUs) for the remaining Evaluation & Management codes were increased to compensate for this change.

As a result, physicians will no longer be allowed to bill "consult" codes to Medicare; however, these codes are still valid per the AMA. CMS has already published RVUs for the removed "consult" codes, but going forward, the codes will be published without corresponding rates within the MPFS.

We will continue to recognize these consultation codes

Since the AMA still lists "consult" codes as active, Aetna will continue to accept and price these codes as valid after January 1, 2010, except as set forth below. We will continue to pay for these codes, according to your Aetna agreement, for members who are covered under our commercial benefits plans and our Medicare Advantage plans.

Consult codes will no longer be paid for some plans

However, we will no longer recognize or pay for consult codes for members covered under our Medicare OpenSM Plan, a Private Fee-for-Service plan, or for claims from nonparticipating providers filing Medicare Advantage claims. Note that the PFFS plan is a non-contracted plan.

For questions please contact:

Julie E. Lindquist

Market Implementation Specialist

Aetna Provider eSolutions

IL, MN, MT, WI

630.963.0131 ph

860.262.9412 fax

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