Medicare Compliance & Reimbursement

• 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.