Member Login | About | Contact
American Association of Oral and Maxillofacial Surgeons

Practice Management & Allied Staff News & Materials

Consultation Coding Update: Billing Consultations to Medicare when there is More Than One Payer

March 3rd, 2010

Guidance continues to trickle out regarding CMS' decision to stop paying for consultation codes. This became effective for services furnished on or after January 1, 2010. According to CMS MLN Matters article 6740:

Medicare will also no longer recognize the consultation codes for purposes of determining Medicare secondary payments (MSP). In MSP cases, physicians and others must bill an appropriate E/M code for the services previously paid using the consultation codes. If the primary payer for the service continues to recognize consultation codes, physicians and others billing for these services may either:

  • Bill the primary payer an E/M code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with the same E/M code, to Medicare for determination of whether a payment is due; or

  • Bill the primary payer using a consultation code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with an E/M code that is appropriate for the service, to Medicare for determination of whether a payment is due.

Note: The first option may be easier from a billing and claims processing perspective.

AAOMS members should be aware that this is a practice choice. The decision to bill one service to two separate payers with two different codes should be made only after careful consideration of the administrative concerns associated with doing so.