Part B Insider (Multispecialty) Coding Alert

Published on Fri Jan 24, 2014 PDF

Sadly, the Final Rule does not include any RVUs for 99446-99449.

Each year when the new edition of CPT^® is issued, Part B practices get very excited about the potential for payment from newly established codes. Although this does often come to fruition and you are able to collect for new services, practices can also be let down by low or no reimbursement assigned to new codes.

Now that the 2014 Medicare Physician Fee Schedule has been finalized, you can get to know how much reimbursement has been assigned to each code. In addition, some MACs have issued coverage decisions on how to collect for many of the new codes. Unfortunately, however, the hope that many practices had for the new interprofessional telephone/internet consult codes has turned to disappointment. Although some practices suspected that they wouldn’t see payment for these codes, CMS’s latest confirmation of that fact has left many practitioners disappointed.

When RVU Is Zero, You Won’t Collect

The new interprofessional telephone/internet consultation codes went into effect on Jan. 1, so you can technically start billing them if your provider meets the criteria for them and documents the time spent, since 99446-99449 are time-based codes. However, chances are strong that you won’t collect any reimbursement for these codes.

CMS did not assign any relative value units (RVUs) to this code set for 2014, and most Medicaid providers don’t reimburse for these services either. Some private payers might, but even they are quite restrictive in paying these codes.

For example, CareFirst, a Blue Cross Blue Shield provider, states in its Policies and Procedures, “CareFirst does not provide benefits for non-face-to-face services via telephone or internet; or effective 1/1/2014, interprofessional telephone/internet consultations (99446-99449). All of these services are considered ‘integral to/include in’ all other services, whether reported alone or in addition to other services or procedures.”

Therefore, check with your insurer before billing these codes, and if the representatives tell you that these services are payable, get the policies in writing.