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
Code Description
- 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 | $13.32 |
98967 | $26.64 |
98968 | $39.60 |
Code Description
- 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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FAQs: Audio-Only Telehealth and Billing Codes
1. What changes did CMS make regarding audio-only telehealth visits?
CMS expanded Medicare coverage to include audio-only telehealth visits during the COVID-19 pandemic, allowing physicians and other healthcare professionals to be reimbursed for services provided via telephone.
2. What are CPT codes 99441-99443 used for?
CPT codes 99441-99443 are used for audio-only telephone evaluations and management services provided by physicians or other qualified healthcare professionals to established patients. These codes cover telephone consultations that are not part of a previous or upcoming E/M service.
3. How are CPT codes 99441-99443 reimbursed?
CMS now reimburses telephone visits using codes 99441-99443 at the same rates as in-person visits coded 99212-99214, depending on the duration of the medical discussion.
4. Who can use CPT codes 99441-99443?
Physicians, nurse practitioners, clinical nurse specialists, certified nurse-midwives, and physician assistants can bill using these codes for audio-only telehealth visits.
5. What modifier should be added to CPT codes 99441-99443 for telehealth?
Modifier 95 must be added to these codes to indicate that the services were provided via telehealth.
6. What are CPT codes 98966-98968 used for?
CPT codes 98966-98968 are used by non-physician healthcare professionals, such as registered dietitians, social workers, speech-language pathologists, and therapists, for telephone evaluations and management services provided to established patients.
7. What is the difference between CPT codes 99441-99443 and 98966-98968?
Codes 99441-99443 are used by physicians and certain other healthcare professionals, while codes 98966-98968 are used by non-physician professionals like therapists and dietitians for audio-only telehealth services.
8. How much is reimbursed for CPT codes 98966-98968?
For telephone evaluations, 98966 reimburses $13.32, 98967 reimburses $26.64, and 98968 reimburses $39.60 for non-facility settings.
9. What services does Medical Billers and Coders (MBC) provide?
MBC offers services like revenue cycle management and ICD-10 testing solutions for over 40 medical specialties, helping physicians streamline their billing and coding processes.