Medicare has eliminated consulting codes effective January 1, 2010. Providers may still be paid for consulting, however
the way you will submit your claim will be different. To make the elimination of consultation codes less confusing, we have provided
a chart on this page to help you convert the old code to the new code. Commercial/private insurances have not released their rules
as of yet, so continue to bill the same.
Outpatient/Office Setting
Eliminated Code
Replace With (New Patient)
Replace With (Established Patient)
99241
99201
99211
99242
99202
99212
99243
99203
99213
99244
99204
99214
99245
99205
99215
Hospital/Inpatient Setting
Eliminated Code
Replace With (Hospital/Inpatient)
Replace With (Nursing Facility)
99251 - 99255
99221 - 99223
99304 - 99306
Telehealth Consultation
G0425-G0427 - no change
For Hospital/Inpatient settings, the admitting or attending physician will also need to bill with modifier "AI".
Also, if you have not updated your information with Medicare in since November 2003, you must do so in order to refer to other Medicare providers.
In order to update with Medicare's PECOS system, click here.
Outpatient/Office Setting