Consultations Requested by Members of the Same Physician Group

Medicare Consultation Guidelines: CMS Pub. 100-04, Chapter 12, Section 30.6.10.E

According to CMS Pub. 100-04, Chapter 12, Section 30.6.10.E, Medicare carriers pay for a consultation if one physician or qualified NPP in a group practice requests a consultation from another physician in the same group practice when the consulting physician or qualified NPP has expertise in a specific medical area beyond the requesting professional’s knowledge. A consultation service shall not be reported on every patient as a routine practice between physicians and qualified NPPs within a group practice setting.

Consultations continue to be a “hot topic” between the provider community and the Medicare contractor. Complete information regarding consultations versus other evaluation and management visits can be found in CMS Pub. 100-04, Chapter 12, Section 30.6.10 at www.cms.hhs.gov/manuals/downloads/clm104c12.pdf.

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