04/07/2020

MSHO Medicare Update On Billing for Phone Calls to Patients

Late in the afternoon on April 2, 2020, MSHO verified with WPS Medicare that when a physician provides a Telehealth service by audio only (phone call), they CANNOT bill the visit codes and instead must bill the Non-Face-to-Face Telephone Services Codes;

                                Non-Facility
CODE                     National Payment           Description

99441                    $14.41                   5 – 10 minutes of medical discussion

99442                    $28.15                   11 – 20 minutes of medical discussion

99443                    $41.14                   21+ minutes of medical discussion

These codes do require verbal consent

These codes cannot be billed if:

*the call results in a decision to see the patient within the next 24 hours

*7 days following an appointment no leading to a E/M service within the next 24 hours

Additionally within CMS-1744-IFC, CMS references the ability to bill for Non-physician - Non-Face-to-Face - Telephone Services

98966                    $14.41                   5 – 10 minutes of medical discussion

98967                    $28.15                   11 – 20 minutes of medical discussion

98968                    $41.14                   21- 30 minutes of medical discussion

Note:  Refer to your AMA CPT for other rules related to these visits

WHAT MSHO IS DOING: MSHO has submitted a request to CMS for further clarification as well as consideration for use of the E/M visit codes for phone only situations. Additionally, we have requested higher RVUs for the phone calls since phone calls can only be billed based on time. We know that managing our complex cancer patients via telephone is often more difficult than caring for the patient in the office and physicians should be compensated appropriately. We will continue to update our members on further developments.