CPT Coding

As an essential part of the healthcare team, case managers routinely work directly with patients in support of medical management objectives and health care coordination. The processes of health adherence assessment, education and adherence monitoring are well within the scope of case/care management practice.

Professional case/care managers perform these responsibilities as a core function of their jobs. As licensed professionals, case/care managers use proven techniques (e.g., health literacy assessment, readiness to change) in working with patients, caregivers, and fellow healthcare professionals toward measurable improvement in health status.

Recently, additional CPT codes have been approved related to telephone evaluation and management services provided by a physician:

99441: Telephone evaluation and management services provided by a physician 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: The same services as above with 11-20 minutes of medical discussion.

99443: The same services as above with 21-30 minutes of medical discussion.

Furthermore, another three non-physician codes were issued for non face to face telephone services:

98966: Telephone assessment and management services provided by a qualified non-physician health care professional to an established patient, parent or guardian not originating from a related assessment and management service provided within the previous seven days nor leading to an assessment and management services or procedure within the next 24 hours or soonest available appointment: 5-10 minutes of medical discussion.

98967: The same services as above with 11-20 minutes of medical discussion

98968: The same services as above with 21-30 minutes of medical discussion

All of the six new codes identified above are a Status N, which means they are non-payable by Medicare. However, they do have Relative Value Units associated with each, meaning that private payers may cover them.

CMSA believes that by requesting funding support for these six codes, providers will be able to integrate case/care managers support of the Medical Home concept, such as the Medicare Medical Home Demonstration (MMHD), pay for performance programs, and various collaborative models of care which CMSA and other regulatory agencies are discussing.

CMSA urges you to share this information with others within your organization, or with other organizations with which you are affiliated.

Resources:

Read CMSA’s Official Response

Template Letter to Show Your Support