Coverage and Payment of Interprofessional Consultation in Medicaid and the Children’s Health Insurance Program (CHIP)
The Centers for Medicare & Medicaid Services (CMS) is issuing this letter to clarify Medicaid
and CHIP policy for coverage and payment of interprofessional consultations. For purposes of
this letter, interprofessional consultation is defined as a situation in which the patient’s treating
physician or other qualified health care practitioner (hereafter referred to as the treating
practitioner) requests the opinion and/or treatment advice of a physician or other qualified health
care practitioner with specific specialty expertise (hereafter referred to as the consulting
practitioner) to assist the treating practitioner with the patient’s care without patient face-to-face
contact with the consulting practitioner. This letter clarifies that Medicaid and CHIP coverage
and payment of interprofessional consultation is permissible, even when the beneficiary is not
present, as long as the consultation is for the direct benefit of the beneficiary.
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 05, 2023
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.