Bureau of Workers Compensation Policy Alert 

This policy alert addresses the use of the American Medical Association CPT codes for outpatient and inpatient evaluation and management (E/M) consultative services. The Centers for Medicare and Medicaid Services (CMS) no longer reimburse for inpatient and outpatient consultation visits. This action became effective Jan. 1, 2010. Thus, CMS does not recognize current CPT consultation codes (99241-99245 and 99251– 99255).

To continue to facilitate quality medical care, consultative services will remain a covered medical benefit. BWC will continue to recognize and reimburse the current CPT consultation codes mentioned above. Consultations require the following:

• Request for an opinion on a specific problem documented by the treating physician;

• Render and document the opinion by the consultant; and

• Report back to the requesting physician.

Consultative services are distinguished from other E/M codes in that a physician provides his or her opinion regarding the E/M of a specific problem. He or she provides advice after receiving a request to do so. Qualified non-physician practitioners also provide consultations. Do not report ongoing management following the initial consultation service by the consultant with consultation service codes. Report these services as subsequent visits for the appropriate place of service and level of service.

Location: http:// www.ohiobwc.com/downloads/blankpdf/BRM3.pdf  (Chapter 3)