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Reimbursement Policy Update: Consultation Services Payment

Effective June 15, 2021, Horizon BCBSNJ will expand our Consultation Services Payment Policy beyond its Medicare Advantage plans to apply to Horizon BCBSNJ Commercial and Administrative Services Only (ASO) plans.

This change will allow Horizon BCBSNJ to more fully align our approach to consultation services with the Centers for Medicare & Medicaid Services’ (CMS’s) standards by no longer recognizing Current Procedural Terminology (CPT®) consultation codes (99241 through 99245) as being eligible for reimbursement for members enrolled in Horizon BCBSNJ Commercial, ASO and Medicare Advantage plans.

Below is a summary of the policy that will apply to Medicare, Commercial and ASO members beginning on June 15, 2021.

  • Horizon BCBSNJ will not consider CPT consultation codes 99241-99245 for reimbursement.
  • Horizon BCBSNJ will consider services when submitted with the recommended new or established evaluation and management (E&M) codes (99201-99205; 99211-99215; 99281-99285).

We encourage you to review our Consultation Services Payment Policy for more information, including a list of alternative codes.

CPT® is a registered mark of the American Medical Association.

Published on: March 15, 2021, 17:40 p.m. ET
Last updated on: April 22, 2021, 05:28 a.m. ET