Procedure code 99441, 99442, 99443 , 98966 - telephone consult

Coding Question: If a radiation oncologist provides E/M services to his/her patients via telephone, can they bill 99441, 99442 and 99443? Also, can a Medicare Provider bill these Procedure codes and, if so, where can the pricing be found on the Medicare Fee Schedule? Can this kind of phone service be billed under any other E/M billing code that is on the Medicare Fee Schedule?

Coding Response:
  Procedure codes 99441 - 99443 describe telephone evaluation and management services provided by a physician to an established patient. The patient or patient’s parent/guardian must initiate the contact as these codes may not be used for calls initiated by a provider. The codes are differentiated according to the length of the medical discussion with the patient. These codes are used only for services personally performed by a physician. Procedure codes 98966-98968 describe telephone services performed by qualified non-physician health care professionals. Medicare has designated all telephone evaluation management codes with a status indicator “N” which indicates the service is not covered by Medicare.  It should be noted that relative value units (RVUs) are listed for these codes in the Medicare Physician Fee Schedule. Therefore, while Medicare does not cover these services, some private payers could potentially cover these services and use the RVUs assigned by Medicare to set payment rates. ASTRO recommends you review the current policies of your major payers to determine their coverage policies regarding telephone evaluation management services. Phone calls during treatment are included in the work captured in Procedure code 77427 which includes a 90-day global period after treatment is completed.

Procedure code 77427: Radiation treatment management, 5 treatments

Procedure code 98966:
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; 5-10 minutes of medical discussion

Procedure code 98967: 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; 11-20 minutes of medical discussion

Procedure code 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

Procedure code 99441: 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; 5-10 minutes of medical discussion

Procedure code 99442: 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; 11-20 minutes of medical discussion

Procedure code 99443: 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; 21-30 minutes of medical discussion

Telephone Calls 

Telephone calls are payable to the attending provider, consultant, psychologist or other provider only when they personally participate in the call. These services are payable when discussing or coordinating care or treatment with:

• The worker
• L&I staff
• Vocational rehabilitation counselors
• Nurse case managers
• Health services coordinators (COHE)
• L&I medical consultants
• Other physicians
• Other providers
• TPAs
• Employers


The insurer will pay for telephone calls if the provider leaves a detailed message for the recipient and meets all of the documentation requirements

Duration procedure code (Physicians) procedure code (Nonphysicians)

1-10 minutes 99441 98966
11-20 minutes 99442 98967
21-30 minutes 99443 98968


Documentation Requirements 

Documentation for case management services (team conferences and telephone calls) must include:
• The date, and
• The participants and their titles, and
• The length of the call or visit, and
• The nature of the call or visit, and
• All medical, vocational or return to work decisions made.

Psychiatrists and clinical psychologists may only bill for these services when also providing consultation or evaluation.

Team conference documentation must also include a goal-oriented, time-limited treatment plan covering:
• Medical,
• Surgical,
• Vocational or return to work activities, or
• Objective measures of function

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