You might spend a lot of time on the phone with your doctor, nurse practitioner (NP), or physician assistant (PA). In some circumstances, you or your health insurer may be billed for these phone consultations as medical services.
In the past, discussing medical issues and getting medical advice over the phone was not reimbursed by insurance or billed to patients.
Recently, some private insurance companies have begun to pay for patient-to-provider phone calls, especially when the calls are prolonged and when medical decisions are made. Nevertheless, you may be billed for the whole cost, or you may have to pay a co-pay.
While you shouldn’t hesitate to call your doctor, you should familiarize yourself with your doctor’s policy and your insurer’s policy about phone calls and online correspondence.
CPT Phone Codes
The American Medical Association (AMA) standardizes Current Procedural Terminology (CPT) codes, which correspond to every medical service. For Medicare patients, these are known as Healthcare Common Procedure Coding System (HCPCS) codes.
Every procedure and service you receive from a medical provider uses these codes, which are required along with your bill. Phone or online consultations with your doctor or other providers have corresponding CPT codes as well.
Calls With a Doctor
Codes that refer to phone conversations with your doctor are billed in time increments from five minutes to a half an hour.
- 99441 phone call 5 to 10 minutes of medical discussion
- 99442 phone call 11 to 20 minutes of medical discussion
- 99443 phone call 21 to 30 minutes of medical discussion
Calls with a Nurse or PA
Codes for phone consultations with physician extenders, who are usually nurses, NPs, or PAs, usually correspond with a bill that is less than the bill for phone conversations with your doctor.
- 98966 phone call 5 to 10 minutes of medical discussion
- 98967 phone call 11 to 20 minutes of medical discussion
- 98968 phone call 21 to 30 minutes of medical discussion
Many doctors, clinics, and hospitals also offer email or other online consultation services to patients. No matter the format, the AMA designates them with two codes: one for your doctor and the other for a physician extender.
- 99444 Email or some other online service to discuss a medical problem with a healthcare provider.
Keep in mind that in addition to the billing issues involved with online correspondence, many doctors and other providers have serious concerns about whether online correspondence about your medical issues could compromise the privacy of your health information.
Costs and Insurance
While there are codes for phone and online medical services, this doesn’t mean that your insurer will pay for them. Many insurance companies are adding coverage for telephone and online health services because it may prevent you from having to go through an unnecessary emergency room visit—which may be both inconvenient and costly.
Not all payers cover non-face-to-face services, and government payers are among those that do not.
If your health insurer does not cover non-face-to-face healthcare services, your provider may bill you for this time or might list the CPT codes on your bill without a corresponding cost of service.
Your providers are permitted to bill you for them as uncovered service, and most providers will let you know about this arrangement ahead of time so that you can plan your phone calls and online correspondence accordingly.
You may wonder why the code would be included on your bill if there is no charge. Many medical practices and large hospital systems document practice parameters, such as time spent with patients or time spent on the phone.
This data helps them adjust scheduling and staffing or decide whether they should start billing for services such as phone calls and online correspondence in the future.
A Word From Get Meds Info
As an empowered patient, you can take more control of your health care if you know how the system and the medical billing process works.
If you consider phone calls and online correspondence convenient forms of communication for your health care, you might decide to choose a healthcare coverage plan that covers these services when it comes time for open enrollment or whenever you switch health insurance coverage.
As telemedicine is becoming more common, people like you often have the option to “see’ the doctor using telemedicine or virtual care, which can be convenient if you don’t want to spend too much time at the doctor’s office.
Of course, emergencies, procedures, and physical examinations still require in-person care, so keep in mind that these types of visits are not useful in every situation.