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:
Blue Cross will begin enforcing the CPT code descriptions on April 1, 2021.
For billing information, please refer to the code descriptions and examples below.
Scenario 1: Billing a telephonic code inappropriately
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
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 |
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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