UnitedHealthcare puts consults on the chopping block

by: Julia Kyles, CPC May 30, 2019

Heads up if your practice reports consults to UnitedHealthcare’s commercial policy: the payer will start to phase out coverage of codes 99241-99255 on June 1.

The payer announced its two-stage plan in its March 2019 bulletin. Coverage will end on June 1 for professionals and practices that have a “participation agreement that includes contract rates determined on a stated year 2010 or later CMS RVU basis.” Coverage will end on Oct. 1 for all other providers. The payer may still cover consultation services “when billed in accordance with the Preventive Care Services Coverage Determination Guideline for services such as lactation counseling,” the bulletin stated, but in general you’ll report the appropriate E/M code based on the location and type of visit.

The payer acknowledged that the change could “have an impact” on participating providers and invited them to contact their network representative with questions and concerns. Providers who are on an older fee schedule were encouraged to get with the times and align their fee schedules with CMS’ “current Relative Value Unit methodology.” Reimbursement for older fee schedules “does not appropriately align with current RVU structure for E/M services and many other procedure codes,” UnitedHealthcare said.

The announcement may seem like déjà vu all over again. UnitedHealthcare moved to cut consult coverage in 2017, but backed off to give “providers more time to adjust to potential changes in their submission of procedure codes for consultation services.”

Oxford, a UnitedHealthCare plan, released a reimbursement policy last year that stated it would cut coverage of consult codes effective Oct. 1, 2018. However, the codes are still covered according to the policy that is currently on the plan’s website .

Will Unitedhealthcare stick to the policy this time? Practices will find out soon, and we'll let you know if the payer has another change of heart.

Blog Tags: claims processing

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