eConsults are a key clinical innovation that can enable improved access to specialty care. eConsults are designed for use in place of a referral or a curbside consult and in lieu of an in-person evaluation by the specialist. For referral questions primarily assessed using clinical data, eConsults have several potential advantages over a standard referral. In appropriate cases, the patient receives timely access to specialist expertise, avoids the costs associated with an office visit (e.g., travel to the health center, a missed half day of work), and maintains relationship continuity with the primary care physician. For patients who face traditional barriers to accessing care, such as transportation costs or specialist availability, eConsults are a helpful resource for obtaining timely specialty input.
Given the demonstrated value of this service, many health insurers, including Medicare, now reimburse for interprofessional consults.
Below are several important policy updates related to eConsults and reimbursement since 2019:
- In 2025, CMS began payment for mental health interprofessional consults codes (CPT G0546, G0547, G0548, G0549, G0550 and G0551) for specialists statutorily restricted to Medicare payment for mental health services such as clinical psychologists, clinical social workers, marriage and family therapists, and mental health counselors. These codes are cross-walked and mirror the interprofessional consults CPT codes.
- In 2025, Medicare began payment for Advanced Primary Care Management (APCM) services, recognizing elements of existing care management and communications technology-based services as part of providing advanced primary care. Interprofessional consults are included in the APCM bundle; therefore, the treating physician cannot bill APCM services and interprofessional consults concurrently.
- In January 2023, the CMS issued a state health official letter allowing and encouraging the coverage of interprofessional consults (PDF) under the Medicaid and CHIP programs, reversing a previous policy.
- In 2019, Medicare approved payment for two new CPT codes (99451, 99452) that reimburse both the treating provider (typically, a primary care provider) and consulting provider for interprofessional consults. Each code is valued at 0.7 wRVU each.