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Let's take a moment to consider the typical workflow in an independent medical practice.
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Primary care physician encounters a clinical question that falls outside of their immediate expertise.
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For example, a dermatologic finding that requires a specialist assessment or a psychiatric evaluation for a patient on multiple medications.
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In a traditional practice, the protocol is a formal referral.
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The referral is sent to the specialist office and the patient waits for availability, which is likely months for an appointment.
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During this time, the referring physician has limited visibility into whether the specialist received the referral, whether it was reviewed, or whether the patient ever scheduled an appointment.
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And that is the state of our healthcare workflow.
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Hurry up and wait for a long time.
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There's got to be a better way.
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I'm Dr.
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Kevin Hallow, Air Force Veteran Surgeon, as well as the co-founder and chief medical officer of Clinician Corps.
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On today's podcast, we're going to talk about a form of reimbursement that hides in plainsight.
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Specifically, I want to talk to you about something that a lot of independent practices don't realize they're already doing leaving money on the table.
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Lots of it.
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Uncollected.
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It's called an interprofessional consult or e-consult, and it changes the revenue dynamic entirely.
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In fact, I'm willing to bet there's money sitting on your table right now that you don't know even exists.
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As a busy physician, you make so many informed decisions in a day.
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Some of those decisions may require the input of another specialist.
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Getting a hold of that specialist is one thing, and actually getting paid for that consultation is another.
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Fortunately for you, Clinician Core helps with both.
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Clinician Core's Practice HQ and Clinician Core's HTC Consult Core creates trusted entities between physicians and their staff and between the different practice HQs.
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Clinician Core can create an auditable documentation and time trail that can be submitted directly for CPT coding and billing.
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How does that work?
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Well, Clinician Core enables both synchronous and asynchronous personalized communication.
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You can simply send a focused message to your colleague consultant.
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You can include relevant things like imaging, lab results, medication reconciliation, and clinical context all through the secure platform.
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The consultant reviews the case asynchronously.
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If the question can be answered without an in-person patient visit, they provide their clinical assessment directly back to the requesting physician or clinician.
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Treatment decisions are made faster.
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Both clinicians have generated documented billable clinical work.
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This is the interprofessional consultation or e-consult, and this is where the revenue opportunity emerges.
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It's one of the most underutilized revenue sources in independent medicine right now, and it is substantial.
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But before we talk about the billing, let me clarify something because I do see that there is confusion about this when I talk to people about it.
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It's not telehealth.
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That is an important operational and financial distinction.
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An interprofessional consultation is a doctor collaborating with another doctor.
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There is no patient present.
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The specialist reviews the case asynchronously, meaning whenever they have time.
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They send back their assessment.
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That's an e-consult.
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The same thing happens in both scenarios.
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You're using technology to connect physicians and clinicians remotely, but the rules are completely different.
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Okay.
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Now let's talk about the billing codes.
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And don't worry, I'll try not to make it too dry, but after all, these are how you actually get paid for this work.
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There are actually two different sets of people billing here: the doctor who requests the consultation and the specialist who provides it.
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Let's start with the requesting clinician, the one who initiates the consult.
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The primary care doctor, the emergency physician, or whoever is treating the patient initially.
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If they spend 16 to 30 minutes pulling together that consultation request, you know, gathering the information, pulling some labs, taking or finding some photos, writing out a clinical question.
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They bill CPT 99452.
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16 to 30 minutes, one code simple.
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Now the specialist, on the other hand, the consultant, they're spending time reviewing the case, thinking through it, generating their assessment.
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That's where the real codes come in.
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And here's where it gets important to pay attention because the codes depend on how long they spend.
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CPT codes 99446 to 99449.
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They span 11 to 30 minutes.
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All of those are what we call telephonic consultations, meaning that the consult is providing an oral summary of their assessment.
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But here's the one thing that matters most for the written or internet consultation.
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CPT 99451.
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That's the code you build when the consult generates and transmits a written report back to the requesting physician.
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And it covers five or more minutes of work.
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For example, a primary care physician or clinician spends 25 minutes assembling a dermatology consult request.
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They gather some information, medication, some treatment history, and then they have this focused clinical question.
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That's work.
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CPT 99452.
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The consulting dermatologist reviews the material, synthesizes the clinical presentation, generates an assessment and recommendations, 18 minutes of documented consultation time.
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That's CPT 99451.
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Two separate billable encounters neither required the patient to schedule a specialist appointment, neither added appointment slots to the dermatologist's schedule.
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Both generated revenue and improved care coordination.
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In 2025, CMS introduced a whole new set of codes specifically for behavioral health consultation.
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These are the G codes, G0546 through G0551.
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Now, behavioral health professionals, such as licensed clinical social workers or marriage and family therapists, psychiatrists, have a dedicated pathway bill to e-consults without having to jump to a bunch of hoops.
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This is significant because it means a primary care physician can now bill for getting a behavioral health consult on a complex patient that's not responding to standard treatment.
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The behavioral health specialist, on the other hand, can bill as well.
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The billing codes are finally catching up.
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Here's an example.
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A primary care physician managing a patient on medications for depression documents inadequate symptom response despite adequate dosing and duration.
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The physician seeks a psychiatric consultation using the e-consult.
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The required information documentation is assembled and it takes 20 minutes.
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That's billable under CPT-99452.
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The consulting psychiatrist receives the request and they review the notes and they generate an assessment with all the clinical reasoning and they transmit that to the requesting physician.
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That's 30 minutes of consultation work by the psychiatrist, and it's billable under HCPCS G0551.
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The time for both clinicians is documented automatically.
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The entire consult thread, the request, the review, the assessment, the transmission.
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All this exists as a single audible clinical record.
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So now, when an auditor or compliance officer looks at it, they see the clear request from treating clinicians, patient consent, time spent, written assessment from the consultation is present, a clear clinical reasoning and recommendation is present, and a permanent record in the patient chart.
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It's bulletproof, it's compliant.
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And guess what?
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It gets paid.
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That's money in your pocket.
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Money that you're not generating now and money you can recapture.
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Okay.
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You may be thinking, Dr.
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Hallow, that sounds great in theory.
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But how do I actually make this work in my practice?
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I can't have specialists working through email or paper notes.
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See, this is precisely why the infrastructure matters.
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This is where a unified communication platform, something purpose-built for clinical collaboration, changes everything.
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Clinician Corps' HCO Practice HQ can pull information from the HR directly without manually copying it.
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It could document time, it could save information for billing.
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All of this is HIPAA compliant and done in a secure fashion.
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The Clinician Corps' HEC Console Corps can get that information then to the specialist and the people working for the specialist via its trusted entity connections.
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It's all done seamlessly for the physicians.
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The concept of an interprofessional consultation is not a new thing.
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I mean, doctors have been calling other doctors for advice for forever.
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But the fact that CMS now recognizes it, codes for it, pays for it, well, that's new.
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Most independent practices are not taking advantage of it.
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Think about your own practice.
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How many times a week do you call a specialist to ask a quick question?
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How many times do you have to refer the patient out only to realize you could have managed this with five, 10, 15 minutes of a specialist input?
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That's consultable revenue sitting in your schedule right now.
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At Clinicia Core, we've put together a detailed guide that walks through every one of these codes, shows you real-world examples of how they work, and most importantly, gives you a compliance checklist so you're documented everything correctly.
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Head to cliniciacore.com and download the eConsult Billing and Workflow Guide.
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It covers the CPT codes, the behavioral health G codes, real scenarios, and the exact documentation requirements so your consultation will actually get paid.
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If you want to see how this works in real time for your specific clinical workflow, schedule a walkthrough with our team.
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We can show you how a unified communication platform makes this seamless, not just for billing, but for actual clinical collaboration.
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That's all we have for today.
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I'm Dr.
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Kevin Hallow, co-founder and chief medical officer of Clinician Corps.
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We are building the infrastructure that lets independent practices unlock the value that's already there and get paid for collaborative care that they're already doing.
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Come join us.
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Thanks for listening.