Medicare stopped paying for consult services on January 1, 2010. Some private insurers continue to pay for these services. These codes are used to report consult services in both the outpatient and inpatient settings. There used to be five levels of care for these services, but now there are only four.
Reimbursement and national utilization data for these services are not available because consults are no longer recognized by Medicare.
For these encounters, the level of care may be selected based on the MDM required for the visit OR based on time spent.
The rules for performing and documenting consult services are covered extensively in the OUTPATIENT CONSULT SERVICES course and the INPATIENT CONSULT SERVICES course, which includes examples for all levels of care as well as detailed explanations of the MDM and time required for each visit.
Outpatient Consult Services
These codes are used to report outpatient consult services.
The 99241 level of care has been deleted.
The 99242 level of care is the lowest level of care for these encounters. This level of care requires straightforward MDM or a total of twenty minutes spent.
The 99243 level of care requires low complexity MDM or a total of 30 minutes spent.
The 99244 level of care requires moderate complexity MDM or a total of forty minutes spent.
The 99245 level of care requires high complexity MDM or a total of fifty-five minutes spent.
Inpatient Consult Services
These codes are used to report inpatient consult services.
The 99251 level of care has been deleted.
The 99252 level of care requires straightforward MDM or a total of thirty-five minutes of time spent.
The 99253 level of care requires low complexity MDM or a total of forty-five minutes spent.
The 99254 level of care requires moderate complexity MDM or a total of sixty minutes spent.
The 99255 level of care requires high complexity MDM or a total of eighty minutes spent.
Reimbursement and national utilization data for these services is not available because they are no longer recognized by Medicare.
The rules for performing and documenting consult services are covered extensively in the OUTPATIENT CONSULT SERVICES course and the INPATIENT CONSULT SERVICES course, which includes examples for all levels of care as well as detailed explanations of the MDM and time required for each visit.