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TRICARE Policy Manual 6010.60-M, April 1, 2015
Evaluation And Management
Chapter 2
Section 5.1
Consultations
Issue Date:  March 3, 1992
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Revision:  C-13, November 15, 2017
1.0  CPT PROCEDURE CODE RANGE
99241 - 99255
2.0  DESCRIPTION
A deliberation with a specialist physician, dentist, or qualified mental health provider requested by the attending physician primarily responsible for the medical care of the patient, with respect to the diagnosis or treatment in any particular case.
3.0  POLICY
3.1  Consultations performed by an individual professional provider at the request of the patient’s attending provider are covered.
3.2  A consulting physician, dentist, or qualified mental health provider may perform a limited examination of a given system or one requiring a complete diagnostic history and examination.
3.3  To qualify as a consultation, a written report to the attending physician of the consultant’s findings is required.
4.0  EXCLUSIONS
4.1  Telephone consultations and telephone toll charges are not covered.
4.2  Staff consultations required by the policies of a hospital or other institution.
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