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Coding Guide For CPT Code 99441, 99442 & 99443

CPT codes 99441, 99442, and 99443 are used to describe medical evaluation and management services provided by qualified healthcare professionals (QHPs) via telephone or other telecommunications systems. These codes are commonly referred to as “telephone services” or “telemedicine services.”

Here’s a coding guide for each of these CPT codes:

  1. CPT code 99441: Telephone evaluation and management service by a qualified healthcare professional, lasting 5-10 minutes, provided to an established patient.

Guidelines:

  • The service must be initiated by the patient or an established caregiver.
  • The service must be medically necessary and within the QHP’s scope of practice.
  • The service must be documented in the patient’s medical record.
  • The service cannot be reported if it is related to a service provided within the previous 7 days and does not result in a face-to-face service within the next 24 hours or at the next available appointment.
  1. CPT code 99442: Telephone evaluation and management service by a qualified healthcare professional, lasting 11-20 minutes, provided to an established patient.

Guidelines:

  • Same as for 99441, but the service must last between 11 and 20 minutes.
  1. CPT code 99443: Telephone evaluation and management service by a qualified healthcare professional, lasting 21-30 minutes, provided to an established patient.

Guidelines:

  • Same as for 99441, but the service must last between 21 and 30 minutes.

It’s important to note that these codes can only be used for services provided via telephone or other telecommunications systems (such as video conferencing), and not for services provided in person. In addition, the services must be provided by a qualified healthcare professional, which includes physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse-midwives.

It’s also important to ensure that your documentation fully supports the medical necessity and scope of the service provided, and that you follow any additional guidelines or requirements set forth by your specific payer or regulatory agency.

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