Payment for telephone calls during the PHE: CMS update

• CMS will pay for phone calls using codes 99441—99443.  These services previously had a status indicator of non-covered. This will continue during the PHE.
• 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 place of service office (11) or outpatient department (19, 22). Since they are now telehealth services, add modifier 95
• CMS  did not add 98966–98968 to the telehealth list
• Physicians, nurse practitioners, and physician assistants should use codes 99441—99443
• Other qualified health care professionals who are enrolled with insurances may use for their services, such as registered dietitians, social workers, speech language pathologists and physical and occupational therapists should use codes 98966—98968, but most payers do not pay for these services

The big news? CMS has changed the rates for codes 99441–99443 to the rates for 99212–99214.

• 99202–99215 still require real-time, interactive audio and visual communication
• Telephone codes 99441–99443 require audio only but will pay at the rates of 99212–99214

These phone call codes had a status indicator of non-covered, but are now covered services. Per the CPT^© definition, phone call codes 99441—99443 and 98966—98968 are services initiated by the patient (CMS did not discuss if this requirement was waived or not). CMS states that it does not intend to continue paying for these when the PHE ends.

They may not be provided if they are in follow-up for a visit within the past 7 days, or if they result in a visit in the next 24 hours, or next available appointment. They are time-based codes.

Physicians, nurse practitioners, clinical nurse specialists, certified nurse midwives and physician assistants use these codes:

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

Registered dietitians, social workers, speech language pathologists and physical and occupational therapists use these codes, but payment will depend on the payer.

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      11-20 minutes

  98968     21-30 minutes

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