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January 2010
Practice Management
Medicare Update: Payment Cuts for Consultation Codes Go Into Effect
IDSA online resources outline changes and financial impact

There’s good news and bad news in Medicare. The good news: Congress in late December postponed until March a planned 21 percent across-the-board cut in physicians’ Medicare payments, a delay intended to give Congress more time to address the issue. IDSA continues to advocate a long-lasting and sustainable solution to the payment problem and joined a coalition of physician groups in a December letter urging Congress to pass a permanent fix.

The bad news:  Despite vigorous opposition from IDSA and other specialty societies, the decision by the Centers for Medicare and Medicaid Services (CMS) to eliminate payments for consultation codes went into effect Jan. 1 (see related IDSA News article).

The change eliminates payments for inpatient (99251-99255) and outpatient (99241-99245) consultation codes. CMS still will allow physicians to bill initial inpatient consultative visits using the hospital admission codes (99221-99223). Follow-up care will continue to be billed using the subsequent hospital visit codes (99231-99233). The financial impact on an individual physician will vary, depending on his or her service mix.

While IDSA and other groups continue to advocate against the consultation codes decision, the Society has developed several resources on IDSA’s website to help members and their staffs better understand the effects of these changes. (You must be logged in to access these resources.) These tools include:

  • an interactive reimbursement calculator that estimates the financial impact of these changes on an individual practice
  • information on how to bill Medicare for consultative services going forward
  • an interactive webinar scheduled for Feb. 23 at noon EST to help answer questions about the changes (Click here to register.)

As Congress worked on health care reform legislation, IDSA urged lawmakers to include an amendment proposed by U.S. Sen. Arlen Specter (D-Pa.) that would delay Medicare’s consultation codes decision for one year. The Society joined more than 20 other physician organizations in a letter and related press release urging this delay to ensure that Medicare beneficiaries are not harmed by the new payment policy. Now that health care reform has stalled, however, there is no clear path forward for the Specter amendment.

IDSA continues to monitor this and other Medicare payment issues and to offer billing and coding resources, including those related to consultations, on the IDSA website.
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