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.