Practice Management

UnitedHealth to align with CMS consultation policy

UnitedHealthcare announces changes that affect how you code for consultations.


Beginning October 1, 2017, UnitedHealthcare (UHC) will align with the Centers for Medicare and Medicaid Services (CMS) consultation policy by reimbursing for the appropriate evaluation and management (E/M) code rather than a consultation code when services are performed at the request of another physician.

In order to prevent processing delays, denials and payment ineligibility, UHC advises physicians to begin reporting the non-consultation E/M code that most accurately represents where a visit occurred and the level of service provided.

UHC will continue to consider consultations performed via telehealth for payment if they are reported with the appropriate HCPCS codes.

Please view page 23 of the UnitedHealthcare June 2017 Network Bulletin for additional information.

Leave a comment Please see our comment policy