Support NCSEPS' Advocacy Initiatives

   

Renew Your NCSEPS Membership


Not a Member? Join NCSEPS Today

Return a completed Membership Application along with payment to the NCSEPS, or join online using one of these links:


2018 NCSEPS Codequest Coding Seminar, Feb. 3

Save the date!

  • Date: February 3, 2018
  • Location: The Grandover Resort and Conference Center, Greensboro
  • Accomodations: For room reservations, call the Grandover at 1-800-472-6301 and mention the NCSEPS for the group rate of $172 per night.
  • Questions? Contact Nancy Lowe at nlowe@ncmedsoc.org or 919-833-3836.


2018 NCSEPS Annual Meeting, Sept. 21-22

Save the date!

  • Date: September 21-22, 2018
  • Location: The Grandover Resort and Conference Center, Greensboro
  • Accomodations: For room reservations, call the Grandover at 1-800-472-6301 and mention the NCSEPS for the group rate of $185 per night.
  • Questions? Contact Nancy Lowe at nlowe@ncmedsoc.org or 919-833-3836.

UHC Notice – Elimination of Consultation Reimbursement

The June 2017 edition of the United Healthcare Bulletin includes notification that UHC will discontinue payment of CPT codes for consultation services (99241-99245 and 99251-99255). The change is effective October 1, 2017. A copy of the notice appears below. I wanted you to be aware in the event this change will impact your practice.

In taking this action, UHC will become the first major carrier to stop paying for consultation codes. Recognizing the detrimental impact that this change will have on patient access to specialty care, the NCSOHNS and the North Carolina Medical Society, along with several other state medical and specialty societies, have signed on to a letter urging UHC to reconsider the policy change or, at the least, to delay implementation until providers have adequate time to properly prepare for the policy change.



UnitedHealthcare Commercial Reimbursement Policies
Revision to the Consultation Services Reimbursement Policy

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.




North Carolina Society for Eye Physicians and Surgeons | PO Box 27167, Raleigh, NC 27611 | Phn: (919) 833-3836 | Fax: (919) 833-2023