QUESTION: Medicare already covers a physician telephone call with G2012. With the recent virtual care coding changes, should I now use 994xx instead?

Subscription question from Bangor, Maine

ANSWER:

CMS made CPT telephone call codes (99441-99443) payable as of March 1, 2020, and increased their reimbursement to make them equivalent to mid-level established patient office visit payments (99212–99214) on April 29, 2020. Previously the telephone call codes 99441-99443 were bundled and therefore not separately payable. However, during the pandemic, these rules have changed, and Medicare will now pay 99441-99443 for telephone calls.

G2012 vs 99441

You can still use G code (G2012) on your claims for telephone calls, but you’ll be cutting yourself short. Reimbursement for G2012 is $32 less than the lowest level of telephone call code (99441 for 5-10 minutes) -around $46 per instance. When your physician spends more than 10 minutes on the phone evaluating a patient, you should instead capture the additional time with the higher-level telephone calls codes (99443 for 11-20 minutes pays $76, 99443 for 21-30 minutes pays $110).

However, before you begin to use these codes there are some things you need to know:

Provider Type:
- 99441-99443 – Nonphysician practitioners (NPP) can bill for their 5-10 minute telephone calls with G2012. However, they are NOT allowed to submit telephone claims using codes 99441-99443 – these are limited to physicians.
- 98966-98968 -Instead, NPPs should use the CPT codes for telephone calls by a “qualified health care provider” (98966-98968).
Similar unrelated E/M requirements: Both sets of codes (99441-99443 and 98966-98968) can be used for new AND established patients. However, they cannot be related to a face-to-face office visit that occurred within the past 7 days, or result in a subsequent office visit for the patient’s problems within 24 hours or the next available appointment.

To support the use of 99441-99443 for your physician telephone visits, ensure documentation related to these phone encounters include the following:

Medical necessity: Detail what occurred during the communication (e.g., patient problem)
Time: An indication of the total amount of time spent in communicating with the patient

G2012 has expanded requirements:

Consent: Include that the patient provided consent for the service.
Patient demographics: Confirm patient identity (e.g., name, date of birth)

To receive additional telemedicine options, and get more detailed information on coding, billing, and getting paid for them, be sure to register for this upcoming online training “Expert Answers to Your Telemedicine Billing Questions Via Online Q&A.”

Read the Medicare announcement at CMS Flexibilities to Fight COVID-19