Clarification of Evaluation and Management Payment Policy
In the Calendar Year (CY) 2010 Physician Fee Schedule (PFS) final rule with comment period (CMS-1413-FC), the Centers for Medicare and Medicaid Services (CMS) eliminated the payment of all Current Procedural Terminology (CPT) consultation codes (inpatient and office/outpatient codes) for various places of service except for telehealth consultation Healthcare Common Procedure Coding
System (HCPCS) G-codes. In the CY 2011 PFS final rule with comment period (CMS-1503-FC), CMS recognized the newly created CPT subsequent observation care codes (99224-99226). All references to billing consultation codes in Pub. 100-02, Medicare Benefit Policy Manual, chapter 15 and Pub. 100-04, Medicare Claims Processing Manual, chapter 12 are revised to reflect the current policy on consultation codes.
References to billing observation care codes in Pub. 100-04, Medicare Claims Processing Manual, chapter 12,
section 30.6 are revised to account for the new subsequent observation care codes (99224-99226).
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 26, 2011
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