Reimbursement for Consultation Services

Blue Cross Blue Shield of North Dakota (BCBSND) has reviewed guidance from the Centers for Medicare & Medicaid Services (CMS) related to the use of outpatient and inpatient consultation codes.  CMS no longer recognized consultation codes as valid codes in the beginning of 2010.  

BCBSND will no longer reimburse these consultation codes effective January 1, 2021. 

  • Outpatient consultation: 99241, 99242, 99243, 99244, 99245
  • Inpatient consultations: 99251, 99252, 99253, 99254, 99255

Consultation services should be reported with an appropriate outpatient or inpatient E&M code representing the location where the visit occurred and the level of complexity of the visit performed. 

For additional information, please reference the new Consultation Services reimbursement policy.