Can a consultation be billed for services performed by a physician within the same group?

In the context of billing for consultations, it’s important to understand how CPT guidelines define a consultation and the context in which it can be billed. A consultation is typically defined as an evaluation performed at the request of another physician or other healthcare provider for a specific opinion or advice regarding a patient's diagnosis or treatment.

The key consideration here is that consultation codes are not intended to be used when the services are provided by a physician of the same group practice. When physicians are within the same group, they are considered part of the same entity in terms of billing. Therefore, billing a consultation in this scenario does not align with the definitions and guidelines established for consultations.

When two physicians collaborate but practice under the same group, the services they provide are usually considered part of the same episode of care and are thus not eligible for separate consultation billing. Instead, the services may be billed under different procedure codes depending on the services rendered, but they would not be classified as consultations.

This distinction is crucial for accurate billing and compliance with CPT coding rules, which is why the assertion that a consultation cannot be billed in this scenario aligns with the current coding standards.