12/22/2014 – E/M Phone Services

Question: Does Medicare reimburse for E/M phone services; CPT codes 99441-99443?


Answer:Medicare considers telephone call codes 99441-99443 (telephone E/M 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 ;…) to be non-covered services.


The physician work resulting from telephone calls is considered to be an integral part of the pre-work and post-work of other physician services, and the fee schedule amount for the latter services already includes payment for the telephone calls. The relative value units for the office visit includes time for work that is spent before and after the visit on items like pulling the chart, reviewing lab results, and calling the patient.


Since the fee schedule includes relative values for 99441-99443, some private and other public payers may pay for the code, but remember that the guidelines are very specific for reporting these codes. The patient must be established to the practice, must have initiated the call to the physician and the information discussed cannot be directly related to a visit seven or less days before the phone call. Also, the call cannot take place when the patient makes an appointment to see the physician regarding the health issue within 24 hours.


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