CPT Codes for Telephone Care

CPT 2008: 99441-99443 and 98966-98968

Effective January 1, 2008, CPT has added six new 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.

The old codes for telephone care (99371-99371) have been deleted from CPT.

Medicare has assigned RVUs and pricing for these new codes, and has announced that they are designated as Non-Covered for 2008. 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 as they appear in CPT 2008. Note that 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 5-10 minutes of medical discussion
  • 99442 11-20 minutes of medical discussion
  • 99243 21-30 minutes of medical discussion

Telephone Services–Non-Physician

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

  • 98966 5-10 minutes of medical discussion
  • 98967 11-20 minutes of medical discussion
  • 98968 21-30 minutes of medical discussion

Coding Guidelines

  • These codes may be reported only for established patients.
  • The patient or patient’s parent/guardian must initiate the contact. These codes may not be used for calls initiated by a provider.
  • Codes 99441-99443 are used only for services personally performed by a physician.
  • Calls resulting in a face-to-face encounter for the same problem within 24 hours (or soonest available urgent appointment) are not reportable. Instead, consider the call part of the pre-service work for the billable E/M service.
  • 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.
  • Do not report a call that is related to and takes place within the postoperative period of a procedure performed by the same physician. These calls are 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.

Documentation Guidelines

  • These are time-based codes, so time spent must be documented.
  • Document the nature of the service and pertinent details for the medical record.