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...