Pediatric Telephone CPT Code Usage Data

A few years ago, I 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 covered telephone calls for years.  Everyone thinks it’s a myth, yet Bigfoot has been spotted long ago.  One SOAPM member (you know who you are) asked for an update on these codes, so here I am.

First, let’s review the present status of the codes in question.  The most important set of codes is the 99441-3, designed for phone calls made by physicians.  [Note that there are some rules about how these codes are used, especially relative to a recent visit to your office.  Here’s a great summary.]

So, where and how are these being used nationally?  Let’s see what I can find:

CPT Code AVG Charge AVG Payment
99441 $16 $9
99442 $49 $17
99443 $59 $18

To be clear, the 99441 volume is 50x that of the 99442 and 99443 combined.  In fact, the volume of the second two codes is so low I don’t think we can conclude much except that they aren’t used often.   The 99441, however, is being paid  in CA, GA, NJ, and SC.  Although most of the payments are private, not all of them are.  Yes, practices are being paid by payers for these codes.

How about the non-physician phone codes?

CPT Code AVG Charge AVG Payment
98966 $15 $11
98967 $39 $16
98968 $- $-

Interesting.  Similar volume between the 99441 and 98966, but it is used by different practices.  That is, those practices using the 99441 are generally not the practices using the 98966.  Now we are looking at MI, TX, PA.  Interestingly, many of the 99441 charges above were not paid at all – but almost every 9896X charge is covered.  I wonder if these are after-hours nurse call programs?

My conclusion so far is that the telephone codes are out in the wild and being paid, but they are in use by approximately 5% of our clients.  I do note that many of the practices who were using the codes in 2009 are not using them today.  They stopped for reasons I haven’t investigated yet.

What about the 99444 (email, doc) or 98969 (email, non-doc)?  I have no data for that.  And all of this data came from 2013, so I also don’t have any of the new 99446-9 codes, either.

It strikes me that any practice with RVU-based contracts ought to be charging for these phone calls…

8 thoughts on “Pediatric Telephone CPT Code Usage Data

  1. For me the logistics of charging for the call, especially when not in the office makes it too time consuming to be of benefit. Perhaps, at least in the office the message can be automatically linked to the charge. When appropriate all one needs to do is hit bill.

  2. You should be able to access your EHR from home…you are, after all, recording the notes from your phone call, right? Billing for the visit should just be a click or two away at that point!

  3. Hi Chip,
    we used these older codes many years ago. Dr. Noaz never did. So when one partner was released,one left to teach, it left just me and Dr. Noaz. It was left at that time of one person does , one doesn’t so I got to be the bad guy who charged for phone calls. In the interest of harmony OPG stopped charging for phone calls. I agree it is an issue which should be discussed .

  4. I spent 35 minutes on the phone with a mom who had a problem that had going on for 2 weeks Friday night! She is on a Medicaid plan. In Louisiana. Chip-do you have any idea if billing this is a possibility?

Leave a Reply