UnitedHealthcare (UHC), one of the nation's largest Medicare Advantage plan providers, has announced that it will no longer reimburse CPT® codes 99241-99255. UnitedHealthcare will take a phased approach to the change in the consultation services policy. According to UHC, the change aligns UnitedHealthcare with the Centers for Medicare and Medicaid Services (CMS) to end reimbursement codes for consultation services.
The Centers for Medicare and Medicaid Services (CMS) ceased reimbursement of consultation services CPT codes in January 2010 and increased the Relative Value Units (RVUs) for E/M codes at that time to offset this shift in its reimbursement methodology.
UHC encourages providers who are on an older fee schedule to modernize their fee schedules to bring them into alignment with CMS's current Relative Value Unit methodology.
The effective dates for the UnitedHealthcare change are:
June 1, 2019, UHC will end reimbursement for CPT® codes 99241-99255 when billed by any health care professional or medical practice with a participation agreement that includes contract rates determined in 2010 or later.
October 1, 2019, UHC will end reimbursement for CPT® codes 99241-99255 when billed by any health care professional or medical practice.
For more details, download UnitedHealthcare's April Bulletin and see page 19.