Medicare Eliminated Consultation Procedure Code Payments

Effective for dates of service on or after January 1, 2010, Medicare eliminated payment for consultation procedure codes. Claims for consultation services provided to MQMB clients must first be submitted to Medicare using evaluation and management (E/M) procedure codes. After Medicare reimbursement has been finalized, Texas Medicaid will consider the E/M services for crossover reimbursement of coinsurance and deductible.

Claims for MQMB clients with the following consultation procedure codes that were submitted with dates of service from January 1, 2010, through July 18, 2011, may have been paid incorrectly by Texas Medicaid:

Procedure Codes:

99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255


When these claims are reprocessed, any payments that were made in error may be deducted from future payments (i.e., recouped). Deductions will be reflected on the providers’ R&S Reports.

For additional information, providers may refer to the article titled “Consultation Procedure Codes to Remain A Benefit for Texas Medicaid and the CSHCN Services Program,” which was published in the May/June 2010 Texas Medicaid bulletin, No. 229, and the article titled “Clarification of Consultation Procedure Codes to Remain a Benefit for Texas Medicaid and CSHCN” which was published on the TMHP website at on March 26, 2010.