This article pertains to Change Request (CR) 6740, which alerts providers that
effective January 1, 2010, the Current Procedural Terminology consultation codes (ranges 99241-99245 and 99251-99255) are no longer recognized for Medicare Part B payment. Effective for services furnished on or after January 1, 2010, providers should code a patient evaluation and management visit with E/M codes that represents WHERE the visit occurs and that identify the COMPLEXITY of the visit performed. See the Key Points section of this article for details.
Key Points
Effective January 1, 2010, local Part B carriers and/or A/B MACs will no longer
recognize AMA Procedure  consultation codes (ranges 99241-99245, and 99251-
99255) for inpatient facility and office/outpatient settings where consultation
codes were previously billed for services in various settings.
2. RHCs and FQHCs will discontinue use of AMA Procedure  consultation codes
99241-99245 and 99251-99255 and should instead use the E/M codes that
most appropriately describe the E/M services that could be described by the
Procedure  consultation codes.
3. In the inpatient hospital setting and nursing facility setting, any physicians and qualified NPPs who perform an initial evaluation may bill an initial hospital care visit code (Procedure  code 99221 – 99223) or nursing facility care visit code (Procedure  99304 – 99306), where appropriate.
4. The principal physician of record will append modifier “-AI” Principal Physician of Record, to the E/M code when billed. This modifier will identify the physician who oversees the patient’s care from all other physicians who may be
furnishing specialty care. All other physicians who perform an initial evaluation
on this patient shall bill only the E/M code for the complexity level performed.

• However, claims that include the “-AI” modifier on codes other than the initial hospital and nursing home visit codes (i.e., subsequent care codes or
outpatient codes) will not be rejected and returned to the physician or provider.
5. For patients receiving hospital outpatient observation services who are
admitted to the hospital as inpatients and who are discharged on the same
date, the physician should report Procedure  codes 99234-99236 (e.g., Code 99234- Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date). If the patient is an inpatient and another physician evaluation is necessary, the physician would bill the initial hospital day code as appropriate (99221-99223).
Otherwise, the physician should use the new or established patient office or
other outpatient visit codes for a necessary evaluation.
6. In the office or other outpatient setting where an evaluation is performed,
physicians and qualified NPPs should report the Procedure  codes (99201 – 99215) depending on the complexity of the visit and whether the patient is a new or established patient to that physician.