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. According to BCBS, consultation claims reported with CPT codes after Nov. 18 will be denied.
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.
After November 18, physicians billing Texas BCBS 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.
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
