Effective for claims with dates of service on or after Oct. 1, 2017, UnitedHealthcare will reimburse the appropriate evaluation
and management (E/M) procedure code which describes the office visit, hospital care, nursing facility care, home service
or domiciliary/rest home care reported in lieu of a consultation services procedure code. This notification will be the first
of several communications to clarify this change in reimbursement strategy supporting our commitment to the Triple Aim of
improving health care services, health outcomes and overall cost of care.
UnitedHealthcare will align with the Centers for Medicare & Medicaid Services (CMS) and no longer reimburse consultation
services represented by CPT codes 99241-99245 and 99251-99255. At the time of the original CMS decision to no longer
recognize these consultation services procedure codes, UnitedHealthcare began pursuit of data analysis and trending to
better understand the use of consultation services codes as reported in the treatment of our commercial members. Similar to
CMS’s findings, our extensive data analysis has revealed misuse of consultation services codes for this population.
The current Relative Value Unit (RVU) assignments reflect numerous changes made during recent years to both E/M codes
and other surgical services creating an overall budget neutral experience supporting this strategy as a more accurate
reflection of services rendered.