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March 16, 2022
Anthem Blue Cross is the latest payor to halt the reimbursement of consultation services. Effective January 1, 2022, Anthem is no longer reimbursing for inpatient and outpatient consultation CPT codes 99241-99245 and 99251-99255 for its for commercial insurance products. Instead, providers will need to bill utilizing the appropriate evaluation and management (E/M) procedure code that describes the office visit, hospital care, nursing facility care, home service or domiciliary/rest home care.
Anthem Blue Cross’ announcement follows similar policies previously implemented by Cigna and UnitedHealthcare disallowing reimbursement for consultation services for their commercial product lines.
To view Anthem’s updated policy on consultation codes, click here or visit the anthem.com/ca website.
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