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Telehealth and telephonic codes billing reminder
February 1, 2021

This article is for all providers caring for our members

Consistent with the CPT definition of the telephonic codes 98966-98968 and 99441-99443 and with certain telehealth codes, Blue Cross Blue Shield of Massachusetts will not reimburse for these services when a related evaluation and management (E/M) service has been provided:

  • Within the previous seven days, or
  • When it leads to an E/M service or procedure within the next 24 hours

Blue Cross will begin enforcing the CPT code descriptions on April 1, 2021.

  • Do not report these codes if the service is related to the E/M service provided within the timeframes outlined in the code definition.
  • Report these codes if the service is not related to an E/M service provided within the timeframes outlined in the code definition.

For billing information, please refer to the code descriptions and examples below.

Examples

Scenario 1: Billing a telephonic code inappropriately

  1. A patient is seen on April 1, 2021 for an established patient visit, and E/M code 99213 is billed.
  2. A telephone call related to the April 1 visit occurs between the patient and the provider on April 5, 2021.

The telephone visit should not be reported because it is within the timeframe and related to the original visit. We will only reimburse the established patient visit E/M code 99213.

Scenario 2: Billing a telephonic code appropriately

  1. A patient is seen on May 1, 2021 for an established patient visit, and E/M code 99213 is billed.
  2. On May 25, 2021, the patient and the provider have a telephone call.

The telephone visit should be reported. We will reimburse both the established patient visit E/M code 99213 and the telephone visit CPT, regardless of whether the visits were related. This is because the two visits were not within the same seven-day timeframe.

The list of codes below is included for informational purposes only. This is not a complete list of all the codes containing the CPT code descriptions outlined above. Whether or not a code is listed here does not guarantee coverage or reimbursement.

Code Description
98966 Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
98967 Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
98968 Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion
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 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; 11-20 minutes of medical discussion
99443 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; 21-30 minutes of medical discussion

Resources

Questions?

If you have any questions, please call Network Management and Credentialing Services at 1-800-316-BLUE (2583). As always, thank you for the care you give to your patients—our members.

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