Part B Insider (Multispecialty) Coding Alert

Reader Questions:

Know the Facts on These Telehealth Codes

Published on Mon Dec 13, 2021

Question: With flu season in full swing and the COVID numbers slated to go back up, we are trying to cut down on the number of patients in our office. The physicians at our practice have been performing telehealth calls for patients requiring only an E/M visit. Can you please explain the difference between 99441-99443 CPT^®codes?

AAPC Forum Participant

Answer: You will find three differences between the CPT^®codes and their Medicare-recognized equivalent HCPCS code, 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).

When you examine the descriptors of the CPT^®codes, you’ll notice that each one has a different time range for medical discussion:

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 (…; 11-20 minutes of medical discussion)
99443 (…; 21-30 minutes of medical discussion)

Codes 99442 and 99443 allow for longer calls, so the physician and patient can discuss procedures, symptoms, and treatment plans more in-depth. The descriptor for G2012 calls out a “technology-based service,” which permits the use of a computer to conduct the telehealth visit virtually.

Lastly, CPT^®guidelines preceding 99441-99443 state the patient or guardian must initiate the call, while the physician or qualified healthcare professional (QHP) must initiate a G2012 telehealth visit.

Please note: Despite these codes being in existence prior to the public health emergency (PHE), Medicare did not recognize them for reimbursement. Medicare allows the use of the 99441-99443 for phone-only telehealth visits during the pandemic only. Medicare is currently gathering data about telehealth to determine the appropriateness of telehealth post-pandemic.