Note: We received and have compiled the following information from Alliance and NCTracks and expect that most LME/MCOs will work to mirror something very similarly. WE included the rates and fee schedule for these codes which have just been released by DHHS. (Those
were not included in NCTracks or Alliance's announcement.)
Licensed clinicians and prescribers should begin using the following telephonic codes, appropriate to licensure type, to support current consumers. There is no authorization required for these services. We encourage providers to reference the 2020 CPT Manual for any specific questions regarding the use of these codes.
Alliance is ensuring that these are effective retroactive to services delivered on March 13, 2020.
These codes will be added to contracts that currently have Outpatient and/or E&M codes. Providers do not need to request that these codes be added. Please note that for Medicaid members there will be a limit of one non-physician code and a limit of one physician code per day.
State-funded individuals may receive up to 12 non-physician services and up to 16 physician codes. These codes will initially be active through April 30, 2020. LME/MCOS will send out a provider communications to let you know when the codes are included in their software so that you can submit billing. We ask that you hold off submitting billing until you see this notification to reduce claim denials.
98966
Telephone assessment and management service 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 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 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 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 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 service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion.
99441
Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven 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 provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven 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 provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven 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.