Consultation Services (professional)
Defines reimbursement stance for professional consultation services (inpatient and office/outpatient) and applicable CPT coding guidance for commercial plans offered by Blue Cross Blue Shield - Wisconsin and affiliated Anthem entities; affects professional providers submitting claims for consultations.
No material clinical or coverage changes in this revision.
Consultation Reimbursement Criteria
Consultation reimbursement criteria
Reimbursement policy for professional consultation services:
ALL of the following
- Face-to-face medical consultations billed with inpatient consultation procedure codes (CPT 99252-99255) are not eligible for reimbursement.
- Face-to-face medical consultations billed with office-and-other-outpatient consultation procedure codes (CPT 99242-99245) are not eligible for reimbursement.
ALL of the following
- Report the appropriate office or other outpatient E/M code that describes the services provided: new patient visit CPT 99202-99205 (eligible for reimbursement).
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.