Coding guide for CPT code 99441, 99442 & 99443

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.

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 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

AetnaCignaHumanaUHCMedicare
CPT Codes: 99441-99443
Place of Service (POS)Use POS used for typical services (e.g., POS 11 – Office)Use POS used for typical services (e.g., POS 11 – Office)Use POS used for typical services (e.g., POS 11 – Office)Use POS used for typical services (e.g., POS 11 – Office)Use POS used for typical services (e.g., POS 11 – Office)
ModifierNoneNoneNoneNone95

 

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

Major Code/Column 1Minor Code/Column 2Effective DateDeletion DateModifier/Policy Indicator
994410359T10/1/201412/31/20181-Allowed
994410360T10/1/201412/31/20181-Allowed
994410361T10/1/201412/31/20181-Allowed
994410362T10/1/2014*1-Allowed
994410363T10/1/201412/31/20181-Allowed
994410364T10/1/201412/31/20181-Allowed
994410365T10/1/201412/31/20181-Allowed
994410366T10/1/201412/31/20181-Allowed
994410367T10/1/201412/31/20181-Allowed
994410368T10/1/201412/31/20181-Allowed
994410369T10/1/201412/31/20181-Allowed
994410370T10/1/201412/31/20181-Allowed
994410371T10/1/201412/31/20181-Allowed
994410372T10/1/201412/31/20181-Allowed
994410373T10/1/2014*1-Allowed
994410374T10/1/201412/31/20181-Allowed
994410469T10/1/2017*0-Not allowed
994413659110/1/2015*0-Not allowed
994413659210/1/2015*0-Not allowed
99441937921/1/2018*1-Allowed
99441937931/1/2018*0-Not allowed
99441940021/1/2016*0-Not allowed
99441940031/1/2016*0-Not allowed
99441940041/1/2016*0-Not allowed
99441946601/1/2016*0-Not allowed
99441946621/1/2016*0-Not allowed
99441961271/1/2015*0-Not allowed
99441965234/1/2019*0-Not allowed
99441971511/1/2019*1-Allowed
99441971531/1/2019*1-Allowed
99441971541/1/2019*1-Allowed
99441971551/1/2019*1-Allowed
99441971561/1/2019*1-Allowed
99441971571/1/2019*1-Allowed
99441971581/1/2019*1-Allowed
99441989701/1/2020*1-Allowed
99441989711/1/2020*1-Allowed
99441989721/1/2020*1-Allowed
99441990911/1/2019*0-Not allowed
99441991724/1/2014*0-Not allowed
99441991737/1/2016*1-Allowed
994419917410/1/2017*1-Allowed
994419917710/1/2017*1-Allowed
99441993634/1/201612/31/20171-Allowed
99441993644/1/201612/31/20171-Allowed
99441994241/1/2022*1-Allowed
99441994251/1/2022*1-Allowed
99441994261/1/2022*1-Allowed
99441994271/1/2022*1-Allowed
99441994741/1/2020*0-Not allowed
99441G02504/1/2016*1-Allowed
99441G20611/1/202012/31/20200-Not allowed
99441G20621/1/202012/31/20200-Not allowed
99441G20631/1/202012/31/20200-Not allowed
994420359T10/1/201412/31/20181-Allowed
994420360T10/1/201412/31/20181-Allowed
994420361T10/1/201412/31/20181-Allowed
994420362T10/1/2014*1-Allowed
994420363T10/1/201412/31/20181-Allowed
994420364T10/1/201412/31/20181-Allowed
994420365T10/1/201412/31/20181-Allowed
994420366T10/1/201412/31/20181-Allowed
994420367T10/1/201412/31/20181-Allowed
994420368T10/1/201412/31/20181-Allowed
994420369T10/1/201412/31/20181-Allowed
994420370T10/1/201412/31/20181-Allowed
994420371T10/1/201412/31/20181-Allowed
994420372T10/1/201412/31/20181-Allowed
994420373T10/1/2014*1-Allowed
994420374T10/1/201412/31/20181-Allowed
994420469T10/1/2017*0-Not allowed
994423659110/1/2015*0-Not allowed
994423659210/1/2015*0-Not allowed
99442937921/1/2018*1-Allowed
99442937931/1/2018*0-Not allowed
99442940021/1/2016*0-Not allowed
99442940031/1/2016*0-Not allowed
99442940041/1/2016*0-Not allowed
99442946601/1/2016*0-Not allowed
99442946621/1/2016*0-Not allowed
99442961271/1/2015*0-Not allowed
99442965234/1/2019*0-Not allowed
99442971511/1/2019*1-Allowed
99442971531/1/2019*1-Allowed
99442971541/1/2019*1-Allowed
99442971551/1/2019*1-Allowed
99442971561/1/2019*1-Allowed
99442971571/1/2019*1-Allowed
99442971581/1/2019*1-Allowed
99442989701/1/2020*1-Allowed
99442989711/1/2020*1-Allowed
99442989721/1/2020*1-Allowed
99442990911/1/2019*0-Not allowed
99442991724/1/2014*0-Not allowed
99442991737/1/2016*1-Allowed
994429917410/1/2017*1-Allowed
994429917710/1/2017*1-Allowed
99442993634/1/201612/31/20171-Allowed
99442993644/1/201612/31/20171-Allowed
99442994211/1/2020*0-Not allowed
99442994241/1/2022*1-Allowed
99442994251/1/2022*1-Allowed
99442994261/1/2022*1-Allowed
99442994271/1/2022*1-Allowed
99442994741/1/2020*0-Not allowed
99442G02504/1/2016*1-Allowed
99442G20611/1/202012/31/20200-Not allowed
99442G20621/1/202012/31/20200-Not allowed
99442G20631/1/202012/31/20200-Not allowed
994430359T10/1/201412/31/20181-Allowed
994430360T10/1/201412/31/20181-Allowed
994430361T10/1/201412/31/20181-Allowed
994430362T10/1/2014*1-Allowed
994430363T10/1/201412/31/20181-Allowed
994430364T10/1/201412/31/20181-Allowed
994430365T10/1/201412/31/20181-Allowed
994430366T10/1/201412/31/20181-Allowed
994430367T10/1/201412/31/20181-Allowed
994430368T10/1/201412/31/20181-Allowed
994430369T10/1/201412/31/20181-Allowed
994430370T10/1/201412/31/20181-Allowed
994430371T10/1/201412/31/20181-Allowed
994430372T10/1/201412/31/20181-Allowed
994430373T10/1/2014*1-Allowed
994430374T10/1/201412/31/20181-Allowed
994430469T10/1/2017*0-Not allowed
994433659110/1/2015*0-Not allowed
994433659210/1/2015*0-Not allowed
99443937921/1/2018*1-Allowed
99443937931/1/2018*0-Not allowed
99443940021/1/2016*0-Not allowed
99443940031/1/2016*0-Not allowed
99443940041/1/2016*0-Not allowed
99443946601/1/2016*0-Not allowed
99443946621/1/2016*0-Not allowed
99443961271/1/2015*0-Not allowed
99443965234/1/2019*0-Not allowed
99443971511/1/2019*1-Allowed
99443971531/1/2019*1-Allowed
99443971541/1/2019*1-Allowed
99443971551/1/2019*1-Allowed
99443971561/1/2019*1-Allowed
99443971571/1/2019*1-Allowed
99443971581/1/2019*1-Allowed
99443989701/1/2020*1-Allowed
99443989711/1/2020*1-Allowed
99443989721/1/2020*1-Allowed
99443990911/1/2019*0-Not allowed
99443991724/1/2014*0-Not allowed
99443991737/1/2016*1-Allowed
994439917410/1/2017*1-Allowed
994439917710/1/2017*1-Allowed
99443993634/1/201612/31/20171-Allowed
99443993644/1/201612/31/20171-Allowed
99443994211/1/2020*0-Not allowed
99443994221/1/2020*0-Not allowed
99443994241/1/2022*1-Allowed
99443994251/1/2022*1-Allowed
99443994261/1/2022*1-Allowed
99443994271/1/2022*1-Allowed
99443994461/1/2020*0-Not allowed
99443994471/1/2020*0-Not allowed
99443994741/1/2020*0-Not allowed
99443G02504/1/2016*1-Allowed
99443G20611/1/202012/31/20200-Not allowed
99443G20621/1/202012/31/20200-Not allowed
99443G20631/1/202012/31/20200-Not allowed

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