The Connected Practice

E-Consult Billing: The Revenue Hiding in Your Referrals

Hosted by Dr. Kevin Halow, MD MBA FACS
S3 · Ep8 · 12:14
E-Consult Billing: The Revenue Hiding in Your Referrals

What You'll Learn in This Episode

What is an e-consult, and how is it different from telehealth?

An e-consult is a consultation between two clinicians with no patient present. The treating physician sends a focused clinical question with labs, imaging and medications. The specialist reviews the case on their own time and returns an assessment. Telehealth involves the patient; an e-consult does not.

Can both the requesting and the consulting physician bill for an e-consult?

Yes. The requesting physician reports CPT 99452 for 16 to 30 minutes spent preparing the request. The consulting specialist reports CPT 99451 when they send a written report after 5 or more minutes of review. That makes two separate claims, with no specialist appointment needed.

What is the difference between telephonic and written e-consult codes?

CPT 99446 to 99449 cover telephonic consults with a verbal summary, tiered by time: 5–10, 11–20, 21–30 and 31 or more minutes. CPT 99451 covers a written or internet consultation in which the consultant sends a written report to the requesting physician.

What documentation does an e-consult need to be paid?

Auditors look for: a clear request from the treating clinician documented patient consent the time each clinician spent a written assessment with clinical reasoning a permanent record in the patient chart

About This Episode

In this episode of The Connected Practice, Dr. Kevin Halow, MD MBA, Air Force veteran surgeon and Chief Medical Officer of ClinicianCore, examines one of the most underused reimbursement pathways in independent practice: the interprofessional consultation, or e-consult. Traditional referrals leave patients waiting months and give referring physicians little visibility. An e-consult lets a treating physician send a focused clinical question to a specialist, who reviews the case asynchronously and responds without a patient visit. Dr. Halow explains CPT 99452 for the requesting physician, CPT 99446 to 99449 and 99451 for the consultant, the 2025 behavioral health G-codes, and the documentation auditors expect.

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