Aetna closes the door on office consults

by: Julia Kyles, CPC Mar 3, 2022

Aetna joined the long list of private payers that have cut coverage of office consults (99241-99245) today. The payer announced the change in December 2021:

Starting March 1, 2022, we will no longer pay office consultation codes 99241, 99242, 99243, 99244 and 99245.

The March end date was an extension on the notice Aetna released in September 2021, which gave a December 1, 2021, end date for the policy.

Aetna may have been one of the last major payers that covered office consults, but private payers have been abandoning the code since Medicare stopped coverage in 2010. Medicare cited persistent provider confusion about how to bill the high-dollar visits when it cut coverage. Private payers have rarely given a reason when they cut consults – Aetna didn’t – but it is easy to imagine that private payers are driven by the same concerns.

More turmoil for consults is on the horizon. According to the February 2021: CPT® Editorial Summary of Panel Actions the next revamp of E/M codes will include the deletion of consult codes 99241 and 99251 and revisions to the remaining codes (99242-99245 and 99252-99255).

Maybe these changes will coax private payers or Medicare into reinstating coverage. But the continued uncertainty around consults makes us wonder if practices should bill consults as office visits (99202-99215) even if a private payer or two still covers the service.

Are consults still worth the effort?

Blog Tags: claims processing, private payers

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