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-100, August 3, 2022
1.0 CPT PROCEDURE CODE
S99241 - 99255,
99446 - 99449, 99451, 99452
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 TRICARE covers
consultations performed by a TRICARE-authorized, individual
professional provider at the request of the patient’s attending
provider.
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 The
contractor shall require a written report to the
attending physician of the consultant’s findings to
cover a visit as a consultation.
3.4 TRICARE covers
interprofessional Internet consultations conducted via the Internet
and telephone (Current Procedural Terminology (CPT) codes 99446-99449,
99451, and 99452), including a verbal and written report to the
patient’s treating/requesting physician or other TRICARE-authorized provider.
See Chapter 7, Section 22.1.
4.0 EXCLUSIONS
4.1 Telephone toll
charges are not covered.
4.2 Staff
consultations required by the policies of a hospital or other institution.
5.0 Effective Dates5.1 May 12, 2020,
for telephonic consultations during the Coronavirus Disease 2019
(COVID-19) pandemic.
5.2 July 1, 2022,
for telephonic consultations.
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