As social isolation becomes a reality for increasing numbers of us, many physicians are wondering whether telephone check-ins are reimbursable by private payers, Medicare and Medicaid.

While commercial carriers have been reluctant to reimburse for telephone check-ins in the past, more recently both Medicaid and some private carriers have indicated that they will reimburse for these virtual visits. Here at E Central Medical Management, we are tracking carriers and gathering data so that we can confidently advise our clients on whether or not these claims are actually being honored.

Medicaid and Commercial Carriers

CPT offers codes to report telephone services provided by a physician or other qualified health care professional who may report evaluation and management (E/M) services. These codes can only be reported for an established patient and are not billable if the call results in the patient coming in for a face-to-face service within the next 24 hours (or next available urgent visit). These calls are also not billable if they refer to an E/M service performed within the last seven days. The codes are selected from code range 99441 to 99443 and are based on the time spent: 5-10 minutes, 11-20 minutes, or 21-30 minutes, respectively (see below).

For Medicaid and commercial carriers use the following codes for telephone check-ins:

99441 = 5-10 minutes

99442 =11-20 minutes

99443 =21-30 minutes

Medicare

Medicare terminology refers to telephone check-ins as “Virtual Check-Ins” which are defined as “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 (E/M) 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).”

Medicare guidelines state that coverage will be provided for synchronous audio-only real-time telephone interactions between the patient and billing provider, as well as audio interactions augmented by video. As a Medicare Part B service, virtual check-ins require that the patient is charged a co-payment for this service. CMS limits the Medicare code to established patients only. Virtual Check-Ins can be delivered only by those practitioners authorized to furnish E/M services. Therefore, only physicians and qualified health care professionals are allowed to bill for this service.

For Medicare use the following code for virtual check-ins:

G2012 = 5-10 minutes medical discussion.

Keeping Patients and Providers Safe

Given the current and anticipated situation regarding Covid-19, telephone visits represent a common-sense approach to providing basic E/M services to patients remotely, reducing transmission routes for the virus and ultimately slowing down its exponential spread.

Have Questions?

Feel free to contact Louis Burke, co-founder and owner of E Central, with your questions about billing for telephone check-ins. He can be reached at 516-775-8606 or via email at louisb@ecmmgt.com.