The E-Consult Workgroup Celebrates Primary Care Provider E-Consult Reimbursement by California Department of Health Care Services

Decision reflects the priorities of the E-Consult Workgroup, which supports reimbursement for providers and strengthens equitable access to care 

LARKSPUR, Calif. – November 21, 2024 – The E-Consult Workgroup, a California Health Care Foundation-supported collaborative of managed care plans, health systems, and patient and provider associations educating and advocating for e-consult use, today announced it applauds the recent decision by the California Department of Health Care Services (DHCS) to expand reimbursement to cover treating providers’ time spent in conducting e-consults. In October 2024, DHCS added CPT code 99452 to the Medi-Cal fee schedule, making e-consults reimbursable under the Medi-Cal program for enrolled providers, consistent with the Medicare program coverage policy.

“The workgroup is thrilled to see that policy is now aligning with reality, appropriately reimbursing treating providers for the essential care they provide,” said Timi Leslie, president of BluePath Health, which serves as the administrative backbone for the E-Consult Workgroup. “This shift will help reduce barriers to e-consult participation, acknowledging the time and effort these providers, which are typically primary care physicians, spend in improving their patients’ access to specialty care.”

Electronic consultations, or e-consults, improve treating providers’ ability to better manage their patients’ care through asynchronous communications with specialty care or consulting providers. These services are critical to improving access to care. These services also provide additional benefits to patients, including reduced specialty visit wait times, improved satisfaction rates, and lower costs compared to in-person office visits. E-consult services have been found to have a positive impact on care for the safety net population, including Medi-Cal beneficiaries and uninsured Californians.

“We have worked for over a decade to enhance access to specialty expertise through e-consult,” said Delphine Tuot, MD, Chief of Nephrology, Zuckerberg San Francisco General Hospital. “This will help reduce barriers to e-consult participation, acknowledging the time and effort primary care providers spend in improving their patients’ access to specialty care.”

Prior to this update, California DHCS’s 2018 policy allowed for reimbursement for e-consults delivered by consulting providers, who are usually specialists, adding CPT code 99451 to the Medi-Cal fee schedule. Under that policy, reimbursement was not authorized for treating providers, who are usually primary care providers. 

“For nearly a decade, the California Health Care Foundation (CHCF) has supported California primary care providers’ ability to conduct e-consult, and we are thrilled by DHCS’s efforts to support the sustainability of these programs,” said Diana Camacho, CHCF Senior Program Officer. “E-consult services are an important way to enhance access to care, and improved reimbursement helps ensure that the Californians who need the most support are able to access it.”

To learn more about how to participate in e-consults, or to join the E-Consult Workgroup, contact econsultworkgroup@bluepathhealth.com

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