99441 CPT Code (2023) | Description, Guidelines, Reimbursement, Modifiers & Example
99441 CPT code reports a telephone for services provided by a physician or any other qualified healthcare professional (QHP) related to an E/M service not given within the last seven days within the next 24 hours. This code can be reported for 5-10 minutes of telephone services for an established patient, parent, or guardian.
Introduction
The coronavirus pandemic has launched some new and advanced ways in the medical field. Telehealth and telemedicine are a part of this advanced launch in the health field. Different kinds of coding are available for visiting patients.
The telehealth system monitors these patients. The telemedicine topic will increase with great acceptance in the coming years. Telecommunication and coding systems will provide these services through consulting on call. Different codes are designed to provide the consultation of allergists, immunologists, and others.
Telemedicine and its related area are evolving daily, and more services will be available to ensure the ongoing need for the providers.
Description of CPT code 99441
CPT 99441 can be reported when a physician provides evaluation and management services by telephone for an established patient, guardian, or parent, but only if the service did not originate from a related service provided seven days before or one day after. The code can be reported for a medical discussion of 5-10 minutes by phone.
“The official description is as follows: “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.”
Billing Guidelines
The non-face-to-face telehealth visits of patients require some billing to continue these services. There are billing methods for the telephone services of CPT code 99441 – 99443. The non-face-to-face E/M services refer to CPT codes that qualified health professionals use. An established patient can make telephone calls having certain restrictions.
There is no billing for the patient who makes the call if the call ends with the decision to do a checkup in the next 24 hours or if he demands an urgent appointment.
A patient cannot use the telephone code if the call refers to the service of E/M reported by the qualified health professional within the previous seven days. The E/M visits get initiated through calls attempted by the patient or the guardian of the patient as described below:
99441 CPT code: 5-10 minutes of medical discussion through telecommunication route
99442: 11-20 minutes of medical discussion through telecommunication route
99442: 11-30 minutes of medical discussion through telecommunication route
The payments increased for evaluating and managing the visits for CPT codes 99441, 99442, and 99443. The payment rates are high, about $14 to $41 and $60 to $137 during the pandemic. The timings described above are according to the specific CPT codes. For example, each code has its specific timing in which the patient can use the 99441 code, and charges are revised for 5-10 minutes of discussion.
There are specific guidelines related to the CPT coding system that we will discuss below:
Charging the extra amount: According to the rules of CPT, if the timing of services provided crosses their minimum time level by at least 15 minutes, physicians can charge for their extra services using a new CPT code 99417.
The primary procedure for telemedicine: CPT code 99417 is the code for charging extra after a prolonged timing situation and is a primary procedure for telemedicine. It helps the QHP or physicians dealing with the patient using the 99441 CPT code, and a person can bill each time for 15 minutes regarding the total time.
Determining the service level: This code is helpful for billing within the 15-minute increments used to determine the service level.
Discussion less than 15 minutes: The increments requiring less than 15 minutes are not under the 99441 CPT code.
Codes not billed: The patients with the CPT codes 99354, 99385, 99358, 99415, and 99416 are not billed by physicians under code 99417.
Billing Examples
The following case is an example of when the 99441 CPT code may be billed:
A patient calls who has not been seen in the previous months and complains about the ant bite. The patient is concerned about the treatment and speaks to the physician, who has also treated the patient’s son with anaphylaxis to wasps.
The physician notifies the patient about the symptoms he should keep in mind and explains the reactions that might occur. The physician recommends using an epinephrine autoinjector, and this whole conversation takes about 25 minutes.
After 15 minutes of waiting, the staff called the pharmacy for the autoinjector. Therefore, CPT 99441 can be reported for 10 minutes of telephone services.
