Horizon NJ Health
Outpatient Consultation Services Payment


Effective Date: September 1, 2021


Purpose:

This policy provides changes on how Horizon NJ Health will reimburse outpatient Evaluation and Management (E&M) consultation services. This policy only applies to professional providers.


Scope:

Products included:
  • NJ FamilyCare/Medicaid Plan
  • Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP)

Policy:

For dates of service beginning on September 1, 2021, and thereafter, Horizon NJ Health will deny outpatient consultation services, CPT codes 99241-99245. Instead of billing for consultation codes, providers must use the appropriate evaluation and management code from range 99202-99215, depending on the complexity of the visit and whether the patient is a new or established patient to that physician.