5/29/2023 0 Comments Medicare ivr converter![]() ![]() Authorized procedures are subject to the number of visits on the referral. Referrals submitted without a procedure code will default to a C&T referral (99499). We will pay specialists for performing associated covered services in an office setting, according to current claims processing guidelines. In most areas, consult and treat (C&T) referrals do not need to include the specialists’ procedures. C&T referrals – These are referrals submitted with CPT code 99499.We will only reimburse for the procedure code(s) that matches the code(s) on the referral. Primary care physicians (PCPs) should use these referrals when a member needs care for a specific health reason. Exact procedure code referrals – These are referrals submitted with code(s) other than 99499.Our guidelines for patient referrals allow us to authorize: Timely referrals can also help avoid claims reviews later. Keep costs down by referring your patients to specialists who are covered by their plan.
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