We asked Aetna Commercial if they were going to reimburse consult codes after CMS removed them from the Medicare Physician Fee Schedule and received this response:

Since the AMA still lists “consult” codes as active, Aetna will continue to accept and price these codes as valid after January 1, 2010, except as set forth below. We will continue to pay for these codes, according to your Aetna agreement, for members who are covered under our commercial benefits plans and our Medicare Advantage plans.

However, we will no longer recognize or pay for consult codes for members covered under our Medicare Open^SM Plan, a Private Fee-for-Service plan, or for claims from nonparticipating providers filing Medicare Advantage claims. Note that the PFFS plan is a non-contracted plan.

We hope you find this information helpful. What questions do you have about consult codes? Post a comment and ask us.