Attention! There is an updated version of this communication, Important: Postponement of new AmeriHealth New Jersey policy regarding CPT® consultation codes.
Based on a review of the Centers for Medicare & Medicaid Services (CMS) standards, AmeriHealth New Jersey has created a new policy outlining its reimbursement position on Current Procedural Terminology (CPT) consultation codes. Claim Payment Policy #00.01.64: Consultation Codes was posted as a Notification on October 3, 2017, and will go into effect for AmeriHealth New Jersey members January 1, 2018.
For dates of service on or after January 1, 2018, AmeriHealth New Jersey will align with CMS?s position and will no longer recognize the following CPT consultation codes as eligible for reimbursement:
● 99241 ● 99251
● 99242 ● 99252
● 99243 ● 99253
● 99244 ● 99254
● 99245 ● 99255
When rendering services to AmeriHealth New Jersey members, report the appropriate level of evaluation and management service that represents where the visit occurred and identifies the complexity of the visit performed.
More information
To view the Notification for this policy, visit our Medical Policy Portal and select Accept and Go to Medical Policy Online. Then select Commercial under Active Notifications.
For questions about this policy, please review our Reimbursement Position for Consultation Codes: Frequently Asked Questions (FAQ), which can also be found on AmeriHealth NaviNet® Plan Central in the Frequently Asked Questions section under Administrative Tools & Resources. Note: The FAQ will be updated as more information becomes available.
If you still have questions after reviewing the FAQ, email us at consultcodes@amerihealth.com. Be sure to include your name, contact number, and provider ID number in your email.
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