Starting Nov. 18, Blue Cross and Blue Shield of Texas (BCBSTX) will no longer pay physicians for outpatient or inpatient consultations when they report those services with Current Procedural Terminology (CPT) codes 99242 – 99245 and 99252 – 99255.
Instead, the payer says physicians will need to report consultation services with an appropriate office outpatient or inpatient evaluation and management (E/M) code representing where the visit occurred and its level of complexity.
According to the health plan, consultation claims reported with CPT codes after Nov. 18 will be denied.
At that date, physicians should begin to report consultation services with:
- Initial hospital services codes 99221 – 99223 or subsequent hospital care codes 99231 – 99233 for inpatient services;
- New and established patient visit codes 99202 – 99215 for office and outpatient services; and
- Emergency department codes 99282 – 99285 when a patient visits an emergency department and is sent home.
Texas Medical Association billing and coding staff caution BCBSTX may be slow to process payment as its system is updated.
Moreover, not all E/M codes are a direct CPT match and can vary in documentation requirements, TMA staff say. Physicians should review the documentation requirement for each E/M code they report in case they need to revise their documentation methods.
For more payer updates, visit TMA’s Health Plan News page. To receive more information or to speak directly with TMA billing and coding staff, visit TMA’s comprehensive Physician Payment Resource Center.
Last Updated On
September 03, 2024
Originally Published On
September 03, 2024
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469