Payment Policy Update: Reimbursement for Consultation Codes

Effective for dates of service beginning Nov. 1, 2021, in alignment with guidance from the Centers for Medicare and Medicaid Services, Harvard Pilgrim will no longer reimburse the following outpatient and inpatient evaluation and management (E/M) consultation codes when reported for members of our commercial plans:

  • Outpatient consultation codes: CPT 99241-99245
  • Inpatient consultation codes: CPT 99251-99255

When reporting these services, please bill the most appropriate non-consultative E/M code. For more information, refer to Harvard Pilgrim’s commercial Evaluation and Management and Non-Covered Services Payment Policies, which will be updated to reflect this change.

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