Description of CPT code 99441, 99442 & 99443

Telephone E/M services are provided to a patient, parent, or guardian and do not originate from a related E/M service within the previous seven days and do not lead to an E/M service or procedure within the next 24 hours or soonest available appointment. Telephone services are non-face-to-face encounters originating from the established patient for evaluation or management of a problem provided by a qualified clinician.

The problem may not be related to an E/M encounter that occurred within the previous seven days nor can the problem lead to an E/M encounter or other service within the following 24 hours or next available in-office appointment opening. CPT code 99441 is reported for services lasting five to 10 minutes; CPT code 99442 is reported for services lasting 11 to 20 minutes; and CPT code 99443 is reported for calls lasting 21 to 30 minutes.

99442 11-20 minutes of medical discussion
99443 21-30 minutes of medical discussion

Audio-only telephone evaluation and management (E/M) visits for new and established patients are acceptable, which is important for patients who lack internet and smart phone access. In response to advocacy from organized medicine, in an interim final rule released on April 30, 2020, CMS changed its policy so Medicare payment for the E/M visits (CPT codes 99441-99443) is equivalent to the Medicare payment for office/outpatient visits with established patients effective March 1, 2020.

Telephone codes CPT code 99441–99443 require audio only but will pay at the rates of CPT 99212–99214.

COVID-19-related services should be assigned the appropriate COVID-19 ICD-10 diagnosis code. Coding guidance can be found on the CDC website. Cost-sharing waivers may not be applied to claims that do not include an appropriate COVID-19 ICD-10 diagnosis code.

Code audio-only visit for a new or established patient for COVID-19-related or non-COVID-19-related care for below payers

Many private payers are also covering telephone E/M services as telehealth services delivered using audio-only.

• Whether physicians report the audio-only encounter to a private payer as an office visit (99201-99215) or telephone E/M service (99441-99443) will depend on what the physician is able to document from the encounter. Physicians should report the code that appropriately reflects services rendered.
• UHC will allow office visits (99201-99215) via audio-only for Medicaid and commercial patients. Audio-only encounters for Medicare Advantage members must use the appropriate telephone E/M code (99441-99443).

Telephone E/M services should not be reported when the time spent on the telephone is captured in other services reported, such as:

• if CPT codes 99421-99423 have been reported by the same physician in the previous seven days for the same problem,
• when CPT codes 99339-99340 and 99374-99380 are used for the same call,
• during the same month with CPT codes 99487 and 99489, and
• when performed during the same service period at CPT codes 99495-99496.

ICD 10 CM codes

Non-COVID patient:  Code applicable ICD-10-CM diagnoses

COVID patient: Z11.59, Z03.818, Z20.828, Z11.52, Z20.822, Z86.16, M35.81, M35.89, J12.82

NCCI edits for CPT code 99441, 99442 & 99443