NY Manual
SHP Manual

New York Provider Manual
16.6 Family Planning Services | 16.8 Healthfirst Payment in Full/Member Hold Harmless

16.7 Healthfirst Consultation Payment Policy

In 2010, Medicare implemented a policy to no longer reimburse for consultation services. However, Healthfirst will pay for consultation services. Reimbursement for these services will be based on a new member visit or the hospital case rate. The consultation code mapping for Medicare-based contracts is listed below: 

Billed Service Code
Billed Service Code Description
Paid Service Code
Paid at Rate Code Description
99241
Office consultation for a new or established patient; physicians typically spend 15 minutes face-to-face with the patient and/or family. 
99201
Office or other outpatient visit for the evaluation and management of a new patient; physicians typically spend 10 minutes face-to-face with the patient and/or family. 
99242
Office consultation for a new or established patient; physicians typically spend 30 minutes face-to-face with the patient and/or family. 
99202
Office or other outpatient visit for the evaluation and management of a new patient; physicians typically spend 20 minutes face-to-face with the patient and/or family. 
99243
Office consultation for a new or established patient; physicians typically spend 40 minutes face-to-face with the patient and/or family. 
99203
Office or other outpatient visit for the evaluation and management of a new patient; physicians typically spend 30 minutes face-to-face with the patient and/or family. 
99244
Office consultation for a new or established patient; physicians typically spend 60 minutes face-to-face with the patient and/or family. 
99204
Office or other outpatient visit for the evaluation and management of a new patient; physicians typically spend 45 minutes face-to-face with the patient and/or family. 
99245
Office consultation for a new or established patient; physicians typically spend 80 minutes face-to-face with the patient and/or family. 
99205
Office or other outpatient visit for the evaluation and management of a new patient; physicians typically spend 60 minutes face-to-face with the patient and/or family. 
99251
Inpatient consultation for a new or established patient; physicians typically spend 20 minutes at the bedside and on the patient’s hospital floor or unit. 
99221
Initial hospital care, per day, for the evaluation and management of a patient; physicians typically spend 30 minutes at the bedside and on the patient’s hospital floor or unit. 
99252
Inpatient consultation for a new or established patient; physicians typically spend 40 minutes at the bedside and on the patient’s hospital floor or unit. 
99221
Initial hospital care, per day, for the evaluation and management of a patient; physicians typically spend 30 minutes at the bedside and on the patient’s hospital floor or unit. 
99253
Inpatient consultation for a new or established patient; physicians typically spend 55 minutes at the bedside and on the patient’s hospital floor or unit. 
99222
Initial hospital care, per day, for the evaluation and management of a patient; physicians typically spend 50 minutes at the bedside and on the patient’s hospital floor or unit. 
99254
Inpatient consultation for a new or established patient; physicians typically spend 80 minutes at the bedside and on the patient’s hospital floor or unit. 
99223
Initial hospital care, per day, for the evaluation and management of a patient; physicians typically spend 70 minutes at the bedside and on the patient’s hospital floor or unit. 
99255
Inpatient consultation for a new or established patient; physicians typically spend 110 minutes at the bedside and on the patient’s hospital floor or unit. 
99223
Initial hospital care, per day, for the evaluation and management of a patient; physicians typically spend 70 minutes at the bedside and on the patient’s hospital floor or unit.