• My Account
    • Login
  • Contact Us

CodingIntel

Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

  • Join Today
  • What is CodingIntel
    • About
    • Become a Member
    • FAQ
  • Pricing
  • Free Resources
    • Overview
    • Blog
    • Everyday Coding Q&A
    • Newsletter
    • Can I get paid
  • Coding Library
    • Coding Guides
    • Quick Reference Sheets
    • E/M Services
    • How Physician Services Are Paid
    • Prevention & Screening
    • Care Management & Remote Monitoring
    • Surgery, Modifiers & Global
    • Diagnosis Coding
    • New & Newsworthy
    • Speciality
    • Practice Management
    • E/M Rules Archive
  • Webinars

June 8, 2023

Payment for telephone calls during the PHE: CMS rules for phone calls

Print Friendly, PDF & Email

CMS rules for phone calls has changed during the course of the pandemic.  Prior to the public health emergency these had a status indicator of non-covered.

  • CMS will pay for phone calls using codes 99441—99443.  The status indicator was changed to active at the start of the PHE.  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? In 2020, CMS 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

Want unlimited access to CodingIntel's online library?

Including updates on CPT® and CMS coding changes for 2023

Join Today

Last revised July 27, 2022 - Betsy Nicoletti
Tags: telehealth

CPT®️️ is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.

Audit tool for Modifier 25

Reasonable coders and practitioners can and do disagree about when a separate E/M service is warranted on the day of a minor procedure. This audit tool for modifier 25 will help determine if a separate E/M service should be reported. Using it consistently will help practices be reliable in their determinations and provide support in payer audits. Sign up for our monthly newsletter to download the reference sheet.

Sign Up Now

2023 E/M guidelines for hospital, nursing facility, home and residence services | Webinar

Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. Watch this webinar about all these changes.

Watch it now

Latest Intel

HCC coding: V24 versus V28

Medical practices are assessing the impact of the … Read More...

Reporting the Global Surgical Package | Webinar

Your Guide to Accurately Reporting the Global … Read More...

Coding for telehealth

Updated (again) May 17, 2023.  Will there be more … Read More...

Compliance issues in ICD-10 coding for risk based contracts and HCCs

Everyone loves to read the general guidelines at … Read More...

Browse By Categories

Browse Content

  • Articles
  • Coding Guides
  • Everyday Coding Q&A
  • Videos
  • Can I Get Paid to
  • Blog
  • Webinars

Tags

behavioral health_cpt codes behavioral health_E/M services care management CMS updates Code sets and reimbursement compliance issues CPT codes for preventive services CPT updates critical care services dermatology_essential resource dermatology_procedures E/M frequency data E/M medical decision making E/M overview E/M reference sheets FQHC general surgery_diagnosis coding general surgery_E/M services general surgery_modifiers general surgery_procedures global surgery issues HCC diagnosis coding hospital inpatient/observation ICD-10 coding level of service_history level of service_MDM level of service_time medicare incident-to and shared services minor procedures modifiers newborn care Preventive and problem visits preventive services for medicare primary care_diagnosis coding primary care_E/M services primary care_essential resource primary care_modifiers primary care_other E/M services primary care_preventive services primary care_procedures prolonged care remote physiologic monitoring screening and counseling for behavioral conditions teaching physician rules telehealth

All content on CodingIntel is copyright protected. Any resource shared within the permissions granted here may not be altered in any way, and should retain all copyright information and logos.

  • What is CodingIntel
  • FAQs
  • Terms of Use
  • Privacy Policy
  • Contact

Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

Copyright © 2023, CodingIntel
Privacy Policy