Physician Consultation, Evaluation and Management

Revised: 09-19-2016

Eligible Providers

Physicians enrolled in Minnesota Health Care Programs (MHCP) are eligible to provide consultation services.

Eligible Recipients

Recipients enrolled in MHCP are eligible for physician consultation services.

Covered Services

When a medical physician requests an opinion from a psychiatrist about the recipient’s psychiatric condition, the psychiatrist may bill for a consultation. The consultation must be conducted face-to-face with the recipient.

When a psychiatrist requests a medical physician to assume responsibility for managing the recipient’s non-psychiatric medical care after an initial consultation, the medical physician may bill subsequent hospital care for the medical management of the recipient during the course of a recipient’s psychiatric hospitalization.

Billing

Follow these guidelines when billing consultation services:

· Use the MN–ITS 837P to bill for physician and non-physician services

· Enter the treating provider NPI number for each provider rendering services on each claim line item

· Enter place of service code 21 for all visits in an inpatient setting

· Use the appropriate level procedure codes for all mental health services

· Use modifier GC when billing for residents and modifier HL for interns

· Physician consultation in accordance with evaluation and management services as defined by CPT are covered via telemedicine. See Physician Services for details and billing information. Add GT modifier to indicate the service was provided via telemedicine

· Use codes 99241-99245 for office or other outpatient consultation, new or established patient

· Use codes 99251-99255 for initial inpatient consultations, new or established patient

Legal References

MN Statutes 256B.0625, subd. 3b
MN Statutes 256B.0625, subd. 3
MN Statutes 256B.0625, subd. 4