CPT Codes for Telephone Care

CPT codes: 99441-99444 and 98966-98969 are effective as of January 1, 2009, relating to billing for Patient Phone calls and internet online medical care.

There are six  time-based codes for reporting telephone care. These new codes are intended for use in situations where an established patient is seeking advice or treatment for a problem that does not require a face-to-face visit.

There are two online service codes for reporting patient care provided in an online method.

These telephone codes are time-based codes, so time spent must be documented. Both telephone care and online care require documenting the nature of the service and pertinent details for the medical record.

Medicare has assigned RVUs and pricing for these new codes. At this time Medicare has designated these codes as Non-Covered services. This means that physicians are free to bill–and be paid for–the services described by these codes. Commercial plans will develop their own coverage policies; many will follow Medicare’s lead.

Following are the descriptors for these new Non-Face-to-Face Services.  Please note there are separate sets of codes for use by physicians and non-physician practitioners. Physicians will report codes from the Evaluation and Management chapter of CPT; non-physician practitioners will report codes from the Medicine chapter.

Telephone Services–Physician

Telephone evaluation and management service provided by a physician 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;

99441  effective date: 1/1/2009  Phone E&M by Physician 5 to 10 minutes of medical discussion

99442  effective date: 1/1/2009  Phone E&M by Physician 11 to 20 minutes of medical discussion

99443  effective date: 1/1/2009  Phone E&M by Physician 21 to 31 minutes of medical discussion

Online Services – Physician

99444  effective date: 1/1/2009  Online E&M by Physician of medical discussion

Telephone Services–Non-Physician Healthcare Provider

Telephone assessment and management service provided 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 seven days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment;

98966  effective date: 1/1/2009  Healthcare Provider phone call 5 to 10 minutes of medical discussion

98967  effective date: 1/1/2009  Healthcare Provider phone call 11 to 20 minutes of medical discussion

98968  effective date: 1/1/2009  Healthcare Provider phone call 21 to 30 minutes of medical discussion

Online Services – Non-Physician Healthcare Provider

98969  effective date: 1/1/2009  Online service by Healthcare Provider

Coding Guidelines

• These codes may be reported only for established patients, not new patients.
• The patient or patient’s parent/guardian must initiate the contact. These codes may not be used for calls initiated by a provider.
• Calls resulting in a face-to-face encounter for the same problem within 24 hours are not reportable.
• If the call relates to and occurs within 7 days of another E/M service performed and reported by the same provider for the same problem, the call is not reportable. This also means that a telephone call related to a previous call within 7 days is not reportable, since these codes are themselves an E/M service.
• Calls related to and takes place within the postoperative period of a procedure performed by the same physician are not reportable and considered to be part of the global surgical package.
• Telephone calls should not be reported for care plan oversight or anticoagulation management when the same communication is reported using codes 99339-99340, 99374-99380, or 99363-99364.