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
About Medical Billers and Coders
We are catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders.
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.
Catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.
