E-Consults?

Question:

One of my colleagues told me that she was doing e-consults with other physicians for Medicare and getting paid.  Is this a billable service?

Answer:

Yes! Medicare has added CPT codes 99446-99452 for interprofessional/ telephone/internet/electronic health record (EHR) consultations to the fee schedule, so they are now payable services. These are assessment and management services in which a patient’s treating physician or other qualified health care professional requests the opinion and/or treatment advice from a physician with specific specialty expertise. The consulting physician can assist the treating physician or other qualified health care professional in the diagnosis and/or management of the patient’s problem without patient face-to-face contact with the consulting physician. The consulting physician should not have seen the patient in a face-to-face encounter within the previous 14 days. If the consultation leads to a transfer of care or other face-to-face service within the next 14 days or next available appointment date of the consultant, these codes are not reported.

They are time-based codes and some require verbal and written report, while others require only a written report. More than half your total time must be spent on the medical consultative verbal or internet discussion, but the time you spend reviewing the medical records counts towards your total billable time. The written or verbal request for telephone/internet/EHR advice by the treating/requesting physician or other qualified health care professional should be documented in the patient’s medical record, including the reason for the request. Reimbursement ranges from $18.84 for 5-10 minutes of consultative service to $73.28 for 31 minutes or more of consultative service (based on national rates).

*This response is based on the best information available as of 02/16/23.