Starting Nov. 18, Blue Cross and Blue Shield of Texas (BCBSTX) will no longer pay physicians for outpatient or inpatient consultations when they report those services with Current Procedural Terminology (CPT) codes 99242 – 99245 and 99252 – 99255.
Instead, the payer says physicians will need to report consultation services with an appropriate office outpatient or inpatient evaluation and management (E/M) code representing where the visit occurred and its level of complexity.
According to the health plan, consultation claims reported with CPT codes after Nov. 18 will be denied.
Updated 12/10/2024, to add BCBS website information
Evaluation and Management Coding – Professional Provider Services
Policy Number: CPCP024
Version 1.0
Enterprise Clinical Payment and Coding Policy Committee Approval Date:
August 7, 2024
Plan Effective Date: November 18, 2024
(Blue Cross and Blue Shield of Texas Only
Consultation(s) CPT Codes 99242-99245 ,99252-99255 Effective 11/18/2024, the plan will no longer reimburse for office/outpatient consultation codes (CPT codes 99242–99245) and inpatient consultation codes (CPT codes 99252–99255). Consultation services should be reported with an appropriate office/outpatient or inpatient E/M code representing the location where the visit occurred and the level of complexity of the visit performed, such as code ranges 99221-99223, 99304-99306, and 99202-99215.