Telephone Care

Traditionally, medical care has come to be associated with face-to-face encounters between physicians and patients. But in today’s healthcare environment, telephone care represents a significant and growing part of the time spent in caring for patients.

On January 1, 2008 CPT introduced a new category of Evaluation and Management codes: Non-Face-to-Face Physician Services. Included in this category are three new time-based codes for telephone calls. Also new to CPT 2008 are codes located in the Medicine chapter which may be used by non-physician practitioners for reporting these services.

Like web-visits, telephone calls allow patients to receive medical care or advice without losing time away from work or family responsibilities. Often, a telephone call with a physician can prevent costly and unnecessary emergency room visits. While the assignment of CPT codes for telephone calls does not guarantee third-party reimbursement for these services, their inclusion in CPT does - in effect - provide official recognition by AMA of the validity of non-face-to-face services. The development of these new codes by AMA/CPT is also a response to changing expectations of patients with regard to access to care, and the inclusion of these new codes in CPT provides physicians with a way to code and bill for services that more and more patients are asking for.

History…And Changing History

In the days of fee-for-service medical care, indemnity insurance plans, and higher reimbursement rates, charges for telephone care from physicians were unheard of–and unnecessary. Telephone calls were included as part of the service provided, and considered part of the cost of doing business. Over the years, patients came to have that same perspective, expecting free, 24-hour access to their physicians.

More recently, faced with pressure from health plans, employers, and consumers to control healthcare costs, doctors were designated as “gatekeepers.” Physicians were forced to adapt their styles of practice with an eye towards cost containment, while striving to maintain high quality patient care. Telephone triage, case management, and referrals often substituted for traditional face-to-face visits. Eventually, physicians found themselves providing more and more direct care by telephone in an attempt to meet the demands of health plans and patients for increased access to medical care from their physicians.

Today, faced with the increasing costs of maintaining a medical practice in an environment of flat-line or decreasing reimbursement, many physicians are beginning to seek payment for the time and work involved in providing telephone care. Although telephone care and treatment requires medical judgment and decision making and, like face-to-face visits, involves practice expense and medical liability risks, physicians have almost no experience in being paid for telephone care. Unlike accountants and attorneys whose clients expect to pay for telephone expertise, physicians–as a group–have only recently begun to explore a similar professional model.

Medicare and Commercial Insurance Plans

In 1995 CPT introduced codes 99371 – 99373 in the Case Management section to provide physicians with a way to report and bill for telephone care. Medicare, by declining to assign RVUs for these codes, conveyed a message to commercial payers that telephone care was not recognized as a stand-alone service, but was considered part of the pre- or post-service work of a face-to-face visit. These codes have been deleted as of January 1, 2008.

Medicare has assigned RVUs and pricing for CPT codes 99441-99443 and 98966-98968, and has announced that these codes are designated as Non-Covered for 2008. This means that providers can bill–and be paid for–the telephone calls described by these codes. Commercial insurance plans are free to develop their own coverage and reimbursement policies with regard to non-face-to-face services. Many will follow Medicare’s lead.