Posted May 31, 2024 (Updated August 16, 2024)
Now effective Nov. 18, 2024, we are updating our Clinical Payment and Coding Policy for Evaluation and Management Coding (CPCP024).
The details: Under this revised policy, we will no longer reimburse for outpatient or inpatient consultation using Current Procedural Terminology (CPT®) codes 99242-99245 and 99252-99255.
Consultation services should be reported with an appropriate office outpatient or inpatient evaluation and management code representing the location where the visit occurred and the level of complexity of the visit performed.
What do I need to do? Refer to our Clinical Payment and Coding Policies page to review in detail the revised policy – Evaluation and Management Coding CPCP024.
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This is for informational and educational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider, nor is the information presented intended to replace or supersede any requirements set forth in your contract with BCBSNM. Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment.