How to Increase Reimbursement for Telephone Calls?

CMS recently announced that it will provide parity in payment for telephone/audio-only services. Specifically, Medicare payment for the telephone evaluation and management visits would be equivalent to Medicare payment for office/outpatient visits with established patients’ effective March 1, 2020.

This means that payment for CPT codes 99441-99443 would increase from a range of about $14-$41 to about $46-$110. These services previously had a status indicator of non-covered. Kindly note that CMS did not add 98966–98968 to the telehealth list.

99441-99443 have been added to the telehealth list, so use the place of service that would have been furnished. In most cases, this will be the place of service office (11) or outpatient department (19, 22). Since they are now telehealth services, add modifier 95. Physicians, nurse practitioners, and physician assistants should use codes 99441-99443.

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.

To summarize:

• A broad range of clinicians, including physicians, can now provide certain services by telephone to their patients.
• Medicare payment for the telephone evaluation and management visits (CPT codes 99441-99443) is equivalent to the Medicare payment for office/outpatient visits with established patients effective March 1, 2020.
• When clinicians are furnishing an evaluation and management (E/M) service that would otherwise be reported as an in-person or telehealth visit, using audio-only technology, practitioners may bill using these telephone E/M codes provided that it is appropriate to furnish the service using audio-only technology and all of the required elements in the applicable telephone E/M code (99441-99443) description are met.
• Using the new waiver authority, CMS is also allowing many behavioral health and education services to be furnished via telehealth using audio-only communications. The full list of telehealth services notes which services are eligible to be furnished via audio-only technology, including the telephone evaluation and management.

Code Description:

For physicians, nurse practitioners, and physician assistants:

• CPT 99441 Description: 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.
• CPT 99442: ;11-20 minutes of medical discussion.
• CPT 99443: ;21-30 minutes of medical discussion.

For other qualified health care professionals:

• CPT 98966 Description: 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. National non-facility payment: $13.32.
• CPT 98967 Description: ;11-20 minutes of medical discussion. National non-facility payment: $26.64.
• CPT 98968 Description: ;21-30 minutes of medical discussion. National non-facility payment: $39.60.

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