Non Face-to-Face Code Usage Among PCC Clients

I’ve mentioned the use of telephone codes in pediatric offices a few times previously, but it looks like I may have never actually provided any usage data!  It just so happens that the a good friend asked me, “Are most insurance companies paying for the 96110?” which made me wonder about any changes to the phone codes.  [More about the 96110 tomorrow.]

Although the numbers show an improvement, they are still depressing.  First, the codes I’m talking about: 99441, 99442, 99443 and the new telephone codes 98966, 98967, and 98968.  If you don’t know what these codes are, they are easily Googled and learned about.  I will just assume you know.

First, fewer than 20% of  PCC clients even use these codes.  Fewer than 10% of PCC clients have used these codes more than 20 times.  And only one used the codes more than 100 times.  That’s right – even though these CPT codes have RVU values, descriptions, and are recognized by law (thanks to HIPAA), pediatricians still aren’t using them.

How are they being used?  Well, the 99441 – the lowly “Phone e/m by phys 5-10 min” – makes up nealy 75% of all the usage.  Maybe that’s normal, but we have only one client (and you know who you are!) who has billed the 98966 (same call, but only by a non-doc).  And they have billed only 9 since 1/1/09.

Insert my deep sigh here.

However, here’s the good news.  We have some new payers who are covering these procedures.  They include PHC, Health Assurance, Health New England, Americaid, Alta Bates, Tufts, Aetna, DSHS, CHPW, and others.

Here’s what I can tell you:

Avg Charge/Payment By Code 
 Average Charge  Average Payment
99441
$29 $17
99442 $40 $4
99443 $60 $7

So, we have some odd behavior related to the average reimbursement dropping as the value of the code rises, but it’s easily explained: payers understand the 99441 and are working their way up the ladder.  Although most payers are in the $3-$10 range for these codes, some are paying $14, $27, and even $35 a pop!  Amazing.

Tell me, again, why you aren’t using these codes?

More detail about the 96110 tomorrow.

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  1. […] did a review of the use of and payment for telephone-based CPT codes by our clients.  You can see the data, or read an example of a payer policy covering these codes.  The fact is, private payers have […]

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