As of Jan. 1, CMS no longer recognizes CPT codes 99241-99245 and 99251-99255. Physicians should use the appropriate E/M codes when billing.
Physicians or non-physician practitioners who perform an initial examination at an inpatient or nursing facility setting can use initial hospital care visit codes, CPT 99221–99223, or nursing facility care visit code, CPT 99304–99306, according to the report. The principle physician can also apply an -AI modifier to identify him or her as the physician overseeing the patient’s overall care.
Physicians seeing patients receiving hospital outpatient observation who are not admitted as inpatients can use CPT codes 99217-99220. If additional evaluation by another physician is needed, the additional physician bills the office or other outpatient codes when they provide services to the patient, according to the report.
Additional guidance for hospital outpatient observation and emergency department visits are provided in the report.
Read the MLN Matters report on physician consultation CPT codes (pdf).
