In Response to COVID-19, Medicare Announces Payment for Telephone Visits Will Align with Office Visit Payment

Last Updated: May 1, 2020

doctor-phoneOn April 30, 2020, the Centers for Medicare & Medicare Services (CMS) announced many new changes to support the health care system during the COVID-19 pandemic. Noteworthy among the changes is an increase in payment for telephone visits.

CMS recognizes that many beneficiaries do not have the capability to participate in traditional telehealth services, which require an audio and video synchronous technology. In response to stakeholder requests, CMS will reimburse for telephone services in line with traditional office visits.

The telephone services are:

  • 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 – 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; 11-20 minutes of medical discussion; and
  • 99443 – 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; 21-30 minutes of medical discussion.

In its Interim Final Rule, CMS states it will crosswalk the time requirements of evaluation and management codes to the telephone codes: 99212, 99213, and 99214 will crosswalk to 99441, 99442, and 99443, respectively, for the duration of the public health emergency. This would increase payments for telephone visits from a range of $14-$41 to about $46-110. The payments are retroactive to March 1, 2020.

Work Relative Value Units (wRVU) amounts have been adjusted on an interim basis: .48 for code 99441; .97 for 99442; and 1.5 for 99443.

This new guidance does not include codes 98966 – 98968 since these services are furnished by practitioners who cannot independently bill.

For telehealth services that are not telephone services (codes 99441-99443 and 98966-98968), CMS still requires both audio and video communication technology.

Read CMS’ press release on all of regulatory waivers and rule changes announced on April 30 here.

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