E-Consultation Services (Interprofessional Consultations)

E-Consultation Services (Interprofessional Consultations) are services in which the treating physician or other qualified health care provider requests the opinion and/or treatment advice of a physician or other qualified health provider with specific specialty expertise to assist the treating provider with the member’s care without a face-to-face encounter between the consulting provider and the member.

Consulting providers are to bill using procedure codes 99446-99449, 99451, or G0546-G0550 when participating in a medical consultation as the consulting provider. Consulting providers are not to bill for E-Consultation services if they have had a face-to-face encounter within 14 days of the consultation.

The requesting treating provider is to bill using procedure codes 99452 or G0551. Services for requesting the consultation cannot be reported more than once per 14 days.

E-Consultation services should be submitted with the Place of Service code that reflects where the provider was when the service was provided. E-Consultation services with Place of Service 02 or 10 will deny.