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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

April 2017

Payment Policy Update: Billing Consultation Codes 99241-99245


Effective for dates of service beginning June 15, 2017, Harvard Pilgrim will no longer reimburse for consultation services (CPT codes 99241 – 99245) when the same provider has previously billed for the same or a similar condition for the same member in the previous 12 months.
 
The American Medical Association’s (AMA’s) Current Procedural Terminology (CPT) manual defines a consultation as an evaluation and management service provided at the request of another physician or appropriate source to either recommend care for a specific condition or problem, or to determine whether to accept responsibility for ongoing management of the patient’s entire care or for the care of a specific condition or problem.

For more information, please refer to Harvard Pilgrim’s updated Evaluation & Management Payment Policy.

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