RE: eConsults Expansion
IMPACTED PLANS: Medicaid, HIV SNP, HARP
TO: All MetroPlusHealth Providers
Effective as of March 1, 2025, MetroPlusHealth will reimburse eConsult services for Hospital Outpatient Departments (OPDs), freestanding Diagnostic and Treatment Centers (D&TCs), and Federally Qualified Health Centers (FQHCs).
eConsults are intended for patient-specific treatment questions to be answered by a consultative provider without an in-person visit.
The consultative provider should respond to the eConsult request within three business days.
Billing Guidelines
eConsult claims using the below CPT codes must be used for proper billing and reimbursement. This applies to CPT codes 99451 and 99452 for provider services delivered in the outpatient setting. Both the treating/requesting provider and the consultative provider must be enrolled in the NYS Medicaid program to receive reimbursement for eConsults.
| CPT Code | Billed By | Description |
|---|---|---|
| 99451 | Consultative provider | Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a written report of the patient’s treating/requesting physician or other qualified health care professional, five minutes or more of medical consultative time. |
| 99452 | Treating/Requesting provider | Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes. |
Please refer to https://metroplus.org/press/re-econsults/ for more information regarding eConsults.
If you have any questions regarding this memo, please contact MetroPlusHealth at [email protected].
Thank you.
MetroPlusHealth