The Centers for Medicare & Medicaid Services (CMS) made many changes to adapt patient care amid the COVID-19 pandemic. Expanding Medicare coverage to include a range of services through audio-only telehealth visits is one of them.
Let’s understand some of the basic coding guidelines for audio-only telephone visits:
CPT Code 99441-99443 -audio-only telehealth
- 99441: Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management 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.
- 99442: 11-20 minutes of medical discussion
- 99443: 21-30 minutes of medical discussion
Basic Guidelines for 99441-99443
- Physicians, nurse practitioners, clinical nurse specialists, certified nurse-midwives and physician assistants use these CPT codes.
- Audio-only telephone visits were previously had a status indicator as non-covered services but now CMS will pay for phone calls using codes 99441-99443.
- In most of the cases for 99441-99443, the place of service would be office (11) or outpatient department (19, 22).
- You have to add modifier 95 since they are now telehealth services
- Telephone codes 99441–99443 require audio only but will pay at the rates of 99212–99214
|CPT Code||Non-facility payment||Facility payment|
|99212||$ 46.13||$ 26.31|
|99213||$ 76.04||$ 52.26|
|99214||$ 110.28||$ 80.37|
CPT Code 98966-98968
Other qualified health care professionals who may bill Medicare for their services, such as registered dietitians, social workers, speech-language pathologists, and physical and occupational therapists should use codes 98966-98968.
|CPT Code||Non-facility payment|
- 98966: Telephone evaluation and management service by a qualified non-physician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an evaluation and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
- 98967: Telephone call 11-20 minutes
- 98968: Telephone call 21-30 minutes
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