When Medicare requires a consultation service, which code should be billed?

When Medicare requires a consultation service, which code should be billed?

• A. The consult code
• B. The most appropriate non-consult E/M code
• C. A radiology code
• D. A preventive code

Answer: (B)

Medicare pays for the evaluation and management work actually performed, not for a separate “consult” code when a consultation is requested. So the physician should bill the most appropriate non-consult E/M code that reflects the encounter—based on the history, exam, medical decision making, and place of service. The dedicated consult codes are not the correct way to bill Medicare in these cases, because the service is captured by the standard E/M level that matches the work done. Radiology or preventive codes wouldn’t accurately represent the evaluation performed for the consultation request.

Medicare pays for the evaluation and management work actually performed, not for a separate “consult” code when a consultation is requested. So the physician should bill the most appropriate non-consult E/M code that reflects the encounter—based on the history, exam, medical decision making, and place of service. The dedicated consult codes are not the correct way to bill Medicare in these cases, because the service is captured by the standard E/M level that matches the work done. Radiology or preventive codes wouldn’t accurately represent the evaluation performed for the consultation request.