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UnitedHealthcare to Stop Reimbursing for Certain Consultation Services Codes After October 1
Posted on: 8/2/2017

Be prepared – UnitedHealthcare (UHC) is imposing a new reimbursement policy:

Payment for certain outpatient and inpatient consultation CPT services codes (99241-99245 and 99251-99255) will no longer be permitted for claims with dates of service on or after October 1, 2017.

Instead, UHC will reimburse the appropriate level of evaluation and management (E/M) procedure code to describe the office visit, hospital care, nursing facility care or home service care. In other words, services must be billed with the most appropriate non-consultation E/M code.

UHC’s plan to discontinue reimbursement of consultation services codes follows a similar change that the Centers for Medicare and Medicaid Services implemented back in 2010.

UnitedHealthcare states that the eliminated reimbursement for consultation codes is offset through increased E/M procedure code payment, as well as increased compensation for specific codes built into the relative value units (RVU) formula.

For more information, access the UHC Network Bulletins for June (Page 23) and July (Page 29).


ISMS would like to hear how this policy may impact your practice. Please contact us to share your thoughts or concerns at 800-782-4767 ext. 1470, or by email.

You can also contact us if you need help with the transition of submitting reimbursable procedure codes to UHC. 



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