FLASH: Consultation Codes

After careful consideration, Health Alliance™ has made the decision to stop covering consultations billed with codes 99242-99245 and 99252-99255. Providers should bill the appropriate evaluation and management code in place of the consultation codes. Health Alliance will continue to cover any add-on codes if additional time is needed to evaluate the patient. This change will be applicable to dates of service starting on January 1, 2025. This new rule will apply to all lines of business, including group, individual and Medicare Advantage.

This change will be supported by a new reimbursement guide that will be available on our website at provider.healthalliance.org prior to the effective date.