Revised Guidelines for CPT 99441 - 99443

CMS will pay for phone calls using codes 99441—99443. The 4/30/20 rule adds these to the telehealth list and increased payment for these services

These codes previously had a non-covered status and the Physicians, nurse practitioners, and physician assistants should use codes 99441—99443

• 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 - 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; 11-20 minutes of medical discussion
• 99443 - 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; 21-30 minutes of medical discussion

CMS continues did not add 98966–98968 to the telehealth list,

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

• 98966 - 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 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
• 98967 - 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 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
• 98968 - Telephone assessment and management service provided by a qualified nonphysician 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 assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion

New! 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 has changed the rates for codes 99441–99443 to the rates for 99212–99214.

***Telephone codes 99441–99443 require audio only but will pay at the rates of 99212–99214 

UHC Telehealth Updates

The CMS fee schedule changes for audio-only codes, providers will continue to be reimbursed for audio-only visits at the rate they would receive for audio-video or in-person codes. 

The CMS rates for audio-only telephonic evaluation and management (E/M) codes, as well as virtual check-ins (which may be done by telephone) and e-visits for established patients for dates of service on or after March 1, 2020.

Audio-only visits and other services not requiring video technology include 

Audio-only (telephone) E/M services 

• 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 - 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; 11-20 minutes of medical discussion
• 99443 - 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; 21-30 minutes of medical discussion 
  

Online digital E/M services/e-visits 

• 99421 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
• 99422 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
• 99423 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
• 98970 - Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
• 98971 - Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
• 98972 - Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
  

Virtual check Codes

• G2010 - Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, 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
• G2012 - Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, 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

And additional codes starting Jan. 1, 2021

• G2250 - Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment
• G2251 - Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion
• G2252 - Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, 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; 11-20 minutes of medical discussion
  

Audio and video visits and other services requiring video technology include,

• The service rendered through “real-time;” a two-way, face-to-face interaction between a patient and a provider using audiovisual communications technology.
• Office and or Outpatients CPT codes 99201 - 99215
  

Place Of Service

 

United HealthCare initially covered the service when submitted with a place of service with modifier 95, but effective from Jan 1st, 2021, the UHC denied as the service billed with an inappropriate place of service or invalid.

The UHC shared the billing guidelines for telehealth states as following,

Starting Jan 1st, 2021, eligible telehealth service will be considered for reimbursement when reported with a place of service (POS) 02. Modifier 95, GT, GQ, GO not required and the place of service 02 will be considered the service rendered through telehealth.

Telehealth CPT

Telehealth Services

The below list of services payable under the Medicare Physician Fee Schedule when furnished via telehealth during the PHE (Public Health Emergency)

CPT Short Descriptor

77427 Radiation tx management x5

90785 Psytx complex interactive

90791 Psych diagnostic evaluation

90792 Psych diag eval w/med srvcs

90832 Psytx w pt 30 minutes

90833 Psytx w pt w e/m 30 min

90834 Psytx w pt 45 minutes

90836 Psytx w pt w e/m 45 min

90837 Psytx w pt 60 minutes

90838 Psytx w pt w e/m 60 min

90839 Psytx crisis initial 60 min

90840 Psytx crisis ea addl 30 min

90845 Psychoanalysis

90846 Family psytx w/o pt 50 min

90847 Family psytx w/pt 50 min

90853 Group psychotherapy

90875 Psychophysiological therapy

90951 Esrd serv 4 visits p mo <2yr

90952 Esrd serv 2-3 vsts p mo <2yr

90953 Esrd serv 1 visit p mo <2yrs

90954 Esrd serv 4 vsts p mo 2-11

90955 Esrd srv 2-3 vsts p mo 2-11

90956 Esrd srv 1 visit p mo 2-11

90957 Esrd srv 4 vsts p mo 12-19

90958 Esrd srv 2-3 vsts p mo 12-19

90959 Esrd serv 1 vst p mo 12-19

90960 Esrd srv 4 visits p mo 20+

90961 Esrd srv 2-3 vsts p mo 20+

90962 Esrd serv 1 visit p mo 20+

90963 Esrd home pt serv p mo <2yrs

90964 Esrd home pt serv p mo 2-11

90965 Esrd home pt serv p mo 12-19

90966 Esrd home pt serv p mo 20+

90967 Esrd svc pr day pt <2

90968 Esrd svc pr day pt 2-11

90969 Esrd svc pr day pt 12-19

90970 Esrd svc pr day pt 20+

92002 Eye exam new patient

92004 Eye exam new patient

92012 Eye exam establish patient

92014 Eye exam&tx estab pt 1/>vst

92507 Speech/hearing therapy

92508 Speech/hearing therapy

92521 Evaluation of speech fluency

92522 Evaluate speech production

92523 Speech sound lang comprehen

92524 Behavral qualit analys voice

92526 Oral function therapy

92550 Tympanometry & reflex thresh

92552 Pure tone audiometry air

92553 Audiometry air & bone

92555 Speech threshold audiometry

92556 Speech audiometry complete

92557 Comprehensive hearing test

92563 Tone decay hearing test

92565 Stenger test pure tone

92567 Tympanometry

92568 Acoustic refl threshold tst

92570 Acoustic immitance testing

92587 Evoked auditory test limited

92601 Cochlear implt f/up exam <7

92602 Reprogram cochlear implt <7

92603 Cochlear implt f/up exam 7/>

92604 Reprogram cochlear implt 7/>

92607 Ex for speech device rx 1hr

92608 Ex for speech device rx addl

92609 Use of speech device service

92610 Evaluate swallowing function

92625 Tinnitus assessment

92626 Eval aud funcj 1st hour

92627 Eval aud funcj ea addl 15

93750 Interrogation vad in person

93797 Cardiac rehab

93798 Cardiac rehab/monitor

94002 Vent mgmt inpat init day

94003 Vent mgmt inpat subq day

94004 Vent mgmt nf per day

94005 Home vent mgmt supervision

94664 Evaluate pt use of inhaler

95970 Alys npgt w/o prgrmg

95971 Alys smpl sp/pn npgt w/prgrm

95972 Alys cplx sp/pn npgt w/prgrm

95983 Alys brn npgt prgrmg 15 min

95984 Alys brn npgt prgrmg addl 15

96105 Assessment of aphasia

96110 Developmental screen w/score

96112 Devel tst phys/qhp 1st hr

96113 Devel tst phys/qhp ea addl

96116 Nubhvl xm phys/qhp 1st hr

96121 Nubhvl xm phy/qhp ea addl hr

96125 Cognitive test by hc pro

96127 Brief emotional/behav assmt

96130 Psycl tst eval phys/qhp 1st

96131 Psycl tst eval phys/qhp ea

96132 Nrpsyc tst eval phys/qhp 1st

96133 Nrpsyc tst eval phys/qhp ea

96136 Psycl/nrpsyc tst phy/qhp 1st

96137 Psycl/nrpsyc tst phy/qhp ea

96138 Psycl/nrpsyc tech 1st

96139 Psycl/nrpsyc tst tech ea

96156 Hlth bhv assmt/reassessment

96158 Hlth bhv ivntj indiv 1st 30

96159 Hlth bhv ivntj indiv ea addl

96160 Pt-focused hlth risk assmt

96161 Caregiver health risk assmt

96164 Hlth bhv ivntj grp 1st 30

96165 Hlth bhv ivntj grp ea addl

96167 Hlth bhv ivntj fam 1st 30

96168 Hlth bhv ivntj fam ea addl

96168 Hlth bhv ivntj fam ea addl

96170 Hlth bhv ivntj fam wo pt 1st

96171 Hlth bhv ivntj fam w/o pt ea

97110 Therapeutic exercises

97112 Neuromuscular reeducation

97116 Gait training therapy

97129 Ther ivntj 1st 15 min

97130 Ther ivntj ea addl 15 min

97150 Group therapeutic procedures

97151 Bhv id assmt by phys/qhp

97152 Bhv id suprt assmt by 1 tech

97153 Adaptive behavior tx by tech

97154 Grp adapt bhv tx by tech

97155 Adapt behavior tx phys/qhp

97156 Fam adapt bhv tx gdn phy/qhp

97157 Mult fam adapt bhv tx gdn

97158 Grp adapt bhv tx by phy/qhp

97161 Pt eval low complex 20 min

97162 Pt eval mod complex 30 min

97163 Pt eval high complex 45 min

97164 Pt re-eval est plan care

97165 Ot eval low complex 30 min

97166 Ot eval mod complex 45 min

97167 Ot eval high complex 60 min

97168 Ot re-eval est plan care

97530 Therapeutic activities

97535 Self care mngment training

97542 Wheelchair mngment training

97750 Physical performance test

97755 Assistive technology assess

97760 Orthotic mgmt&traing 1st enc

97761 Prosthetic traing 1st enc

97802 Medical nutrition indiv in

97803 Med nutrition indiv subseq

97804 Medical nutrition group

99202 Office/outpatient visit new

99203 Office/outpatient visit new

99204 Office/outpatient visit new

99205 Office/outpatient visit new

99211 Office/outpatient visit est

99212 Office/outpatient visit est

99213 Office/outpatient visit est

99214 Office/outpatient visit est

99215 Office/outpatient visit est

99217 Observation care discharge

99218 Initial observation care

99219 Initial observation care

99220 Initial observation care

99221 Initial hospital care

99222 Initial hospital care

99223 Initial hospital care

99224 Subsequent observation care

99225 Subsequent observation care

99226 Subsequent observation care

99231 Subsequent hospital care

99232 Subsequent hospital care

99233 Subsequent hospital care

99234 Observ/hosp same date

99235 Observ/hosp same date

99236 Observ/hosp same date

99238 Hospital discharge day

99239 Hospital discharge day

99281 Emergency dept visit

99282 Emergency dept visit

99283 Emergency dept visit

99284 Emergency dept visit

99285 Emergency dept visit

99291 Critical care first hour

99292 Critical care addl 30 min

99304 Nursing facility care init

99305 Nursing facility care init

99306 Nursing facility care init

99307 Nursing fac care subseq

99308 Nursing fac care subseq

99309 Nursing fac care subseq

99310 Nursing fac care subseq

99315 Nursing fac discharge day

99316 Nursing fac discharge day

99324 Domicil/r-home visit new pat

99325 Domicil/r-home visit new pat

99326 Domicil/r-home visit new pat

99327 Domicil/r-home visit new pat

99328 Domicil/r-home visit new pat

99334 Domicil/r-home visit est pat

99335 Domicil/r-home visit est pat

99336 Domicil/r-home visit est pat

99337 Domicil/r-home visit est pat

99341 Home visit new patient

99342 Home visit new patient

99343 Home visit new patient

99344 Home visit new patient

99345 Home visit new patient

99347 Home visit est patient

99348 Home visit est patient

99349 Home visit est patient

99350 Home visit est patient

99354 Prolong e&m/psyctx serv o/p

99355 Prolong e&m/psyctx serv o/p

99356 Prolonged service inpatient

99357 Prolonged service inpatient

99406 Behav chng smoking 3-10 min

99407 Behav chng smoking > 10 min

99441 Phone e/m phys/qhp 5-10 min

99442 Phone e/m phys/qhp 11-20 min

99443 Phone e/m phys/qhp 21-30 min

99468 Neonate crit care initial

99469 Neonate crit care subsq

99471 Ped critical care initial

99472 Ped critical care subsq

99473 Self-meas bp pt educaj/train

99475 Ped crit care age 2-5 init

99476 Ped crit care age 2-5 subsq

99477 Init day hosp neonate care

99478 Ic lbw inf < 1500 gm subsq

99479 Ic lbw inf 1500-2500 g subsq

99480 Ic inf pbw 2501-5000 g subsq

99483 Assmt & care pln pt cog imp

99495 Trans care mgmt 14 day disch

99496 Trans care mgmt 7 day disch

99497 Advncd care plan 30 min

99498 Advncd care plan addl 30 min

0373T Adapt bhv tx ea 15 min

S9152 Speech therapy, re-eval

0362T Bhv id suprt assmt ea 15 min

G0108 Diab manage trn  per indiv

G0109 Diab manage trn ind/group

G0270 Mnt subs tx for change dx

G0296 Visit to determ ldct elig

G0396 Alcohol/subs interv 15-30mn

G0397 Alcohol/subs interv >30 min

G0406 Inpt/tele follow up 15

G0407 Inpt/tele follow up 25

G0408 Inpt/tele follow up 35

G0410 Grp psych partial hosp 45-50

G0420 Ed svc ckd ind per session

G0421 Ed svc ckd grp per session

G0422 Intens cardiac rehab w/exerc

G0423 Intens cardiac rehab no exer

G0424 Pulmonary rehab w exer

G0425 Inpt/ed teleconsult30

G0426 Inpt/ed teleconsult50

G0427 Inpt/ed teleconsult70

G0438 Ppps, initial visit

G0439 Ppps, subseq visit

G0442 Annual alcohol screen 15 min

G0443 Brief alcohol misuse counsel

G0444 Depression screen annual

G0445 High inten beh couns std 30m

G0446 Intens behave ther cardio dx

G0447 Behavior counsel obesity 15m

G0459 Telehealth inpt pharm mgmt

G0506 Comp asses care plan ccm svc

G0508 Crit care telehea consult 60

G0509 Crit care telehea consult 50

G0513 Prolong prev svcs, first 30m

G0514 Prolong prev svcs, addl 30m

G2086 Off base opioid tx 70min

G2087 Off base opioid tx, 60 m

G2088 Off base opioid tx, add30

G2211 Complex E/M visit add on

G2212 Prolong outpt/office vis

G9685 Acute nursing facility care

COVID-19 Vaccine Updates

The AMA released on Jan 19, 2021,  A fourth COVID-19 vaccine code has been released by the American Medical Association, along with an administration code.  

91303 - Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage, for intramuscular use

0031A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative-free, 5x1010 viral particles/0.5mL dosage, single dose

The Janssen COVID-19 vaccine EUA/approval, providers will report 0031A for the administration of vaccine 91303

Note that Janssen is a single-dose vaccine, requiring a single administration. Providers will not have any reason to report 0031A more than once for a patient in any given year. 

The AMA has also released a National Drug Code: NDC 59676-0580-05.  

The CMS released a list of CPT codes for COVID-19 vaccines which is administered through the intramuscular and approved the below Vaccine/Product Name 

• Pfizer
• Moderna 
• AstraZeneca
• Janssen

Pfizer

91300 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use

0001A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose

0002A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose

Moderna 

 

91301 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use

0011A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose

0012A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose

AstraZeneca

 

91302 - Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage, for intramuscular use

0021A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage; first dose

0022A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage; second dose

 

Janssen

 

91303 - Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage, for intramuscular use

0031A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage, single dose

For Telehealth

Medicare Telehealth Services Update for Nursing Facility

The nursing facility services provided to Medicare patients are covered during the PHE for physicians, non-physician practitioners, nursing facilities, and other providers submitting telehealth claims to Medicare Administrative Contractors (MACs).

For subsequent nursing facility care services, Medicare had limited the patient’s admitting physician or non-physician practitioner to one telehealth visit every 30 days.

CMS is changing this limitation to once every 14 days. Also, you may not furnish or report subsequent nursing facility care services for a Federally-mandated periodic visit through telehealth. 

The frequency limit of the benefit doesn’t apply to consulting physicians or practitioners, who should continue to report initial or follow-up inpatient telehealth consultations using the applicable HCPCS G-codes.

For this edit change, (Common Working File) CWF revises the current line-level edits from once every 30 days to allow a frequency of once every 14 days for the following codes when billed with the GT or GQ modifier or Place of Service (POS) code 02, effective for claims with dates of service on or after January 1, 2021, that are processed on or after July 6, 2021,

Subsequent nursing facility care, Which requires at least 2 of these 3 key components,

• 99307 - A problem focused interval history, A problem focused examination & Straightforward - MDM
• 99308 - An expanded  focused interval history, An expanded  focused examination & Low Complexity MDM
• 99309 - A Detailed interval history, A Detailed examination & Moderate Complexity MDM
• 99310 - A Comprehensive interval history, A Comprehensive examination & High Complexity MDM

 

Click here to view all Telehealth Codes