CPT Code 99441: Appropriate Use
99441 CPT Code Description: Telephone E/M service provided by a physician or other qualified health professional who may report E/M services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
What is the difference between Telehealth services and telephone calls?
Telehealth services are live Interactive Audio and Visual Transmissions of a physician-patient encounter from one site to another, using telecommunications technologies. Telephone calls are non-face to face medical discussions, between a physician or other healthcare professional and a patient, that do not require direct, in-person contact.
99441 CPT code is non-face-to-face E/M services provided to a patient using the telephone by a physician or other QHP who may report E/M services. These codes are used to report episodes of patient care initiated by an established patient or guardian of an established patient. If the telephone service ends with a decision to see the patient within 24 hours or next available urgent visit appointment, the code is not reported; rather the encounter is considered part of the preservice work of the subsequent E/M service, procedure, and visit. Likewise, if the telephone call refers to an E/M service performed and reported by that individual within the previous 7 days (either requested or unsolicited patient follow-up) or within the postoperative period of the previously completed procedure, then the service(s) is considered part of that previous E/M service or procedure.
Do not report 99441-99443, if 99421, 99422, 99423 have been reported by the same provider in the previous 7 days for the same problem.
99441 CPT Code Reimbursement 2020
|CPT Code||Service Description||Office||Facility||RVUs|
|99441||5-10 minutes of medical discussion||$ 14.44||$ 13.35||0.40/0.37|
|99442||11-20 minutes of medical discussion||$ 28.15||$ 26.71||0.78/0.74|
|99443||21-30 minutes of medical discussion||$ 41.14||$ 39.70||1.14/1.10|
*100% Medicare Payment, 2020
If a radiation oncologist provides E/M services to his/her patients via telephone, can they bill 99441, 99442, and 99443?
Procedure codes 99441 – 99443 describe telephone evaluation and management services provided by a physician to an established patient. The patient or patient’s parent/guardian must initiate the contact as these codes may not be used for calls initiated by a provider. The codes are differentiated according to the length of the medical discussion with the patient. These codes are used only for services personally performed by a physician. Procedure codes 98966-98968 describe telephone services performed by qualified non-physician health care professionals. Medicare has designated all telephone evaluation management codes with a status indicator “N” which indicates the service is not covered by Medicare.
It should be noted that relative value units (RVUs) are listed for these codes in the Medicare Physician Fee Schedule. Therefore, while Medicare does not cover these services, some private payers could potentially cover these services and use the RVUs assigned by Medicare to set payment rates. We recommend you review the current policies of your major payers to determine their coverage policies regarding telephone evaluation management services. Phone calls during treatment are included in the work captured in Procedure code 77427 which includes a 90-day global period after treatment is completed.
A Pediatrician receives a call from a mother at 2 A.M. regarding an asthmatic child having difficulty breathing. The physician is able to handle the situation over the phone without requiring the child to be seen in an emergency room. On what basis will the visit be denied?
Most Payers will not reimburse for this service (99441-99443 or 98966-98968) since it did not require direct, in-person patient contact. This service is considered included in the overall management of the patient.
A physician makes daily telephone calls to an unstable diabetic patient to check on the status of his condition. These services are in lieu of clinic visits. Will Payers reimburse the physician for these telephone services?
No, most Payers will not reimburse telephone services (99441-99443 or 98966-98968) since they do not involve direct, in-person patient contact. These services are considered included in the overall management of the patient.
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