Coding Scenario: Coding for Audio-only Visits
Audio-only (Telephone Evaluation and Management)
Note: These tables are informational, not advisory. The AAFP recommends that physicians verify each payer's policy and ask patients to verify their coverage ahead of appointments.
How do I code an audio-only visit for a new or established patient for COVID-19-related or non-COVID-19-related care?
| Aetna | Anthem | Cigna | Humana |
UHC |
Medicare | |
|---|---|---|---|---|---|---|
| CPT Codes: 99441-99443 | ||||||
Place of Service (POS) |
The AAFP is seeking additional information. |
Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) |
Use POS used for typical services (e.g., POS 11 – Office) |
Modifier |
None |
None
|
None |
None |
-95
|
|
Cost-share waiver |
|
Yes (in-network physicians only). Waived for out-of-network physicians for COVID-related visits. |
Yes (in-network physicians only). Waived for out-of-network physicians for COVID-related visits. |
Yes (in-network physicians only). Waived for out-of-network physicians for COVID-related visits. |
Optional |
|
Cover cost-share |
|
Yes |
Yes |
Yes |
No |
|
Audio-only Scenario Notes
Beginning March 1, 2020, and for the duration of the COVID-19 public health emergency, CMS will cover telephone evaluation and management (E/M) services (CPT codes 99441-99443).
Many private payers are also covering telephone E/M services as telehealth services delivered using audio-only.
- Whether physicians report the audio-only encounter to a private payer as an office visit (99201-99215) or telephone E/M service (99441-99443) will depend on what the physician is able to document from the encounter. Physicians should report the code that appropriately reflects services rendered.
- UHC will allow office visits (99201-99215) via audio-only for Medicaid and commercial patients. Audio-only encounters for Medicare Advantage members must use the appropriate telephone E/M code (99441-99443).
Telephone E/M services are provided to a patient, parent, or guardian and do not originate from a related E/M service within the previous seven days and do not lead to an E/M service or procedure within the next 24 hours or soonest available appointment.
The following codes may be used by physicians or other qualified health professionals who may report E/M services:
- 99441: telephone E/M service; 5-10 minutes of medical discussion
- 99442: telephone E/M service; 11-20 minutes of medical discussion
- 99443: telephone E/M service, 21-30 minutes of medical discussion
As noted above, most payers are waiving cost-sharing for telephone E/M services. Physicians may elect to waive cost-sharing for Medicare beneficiaries. However, Medicare will not cover the beneficiary’s cost-sharing and the service will be paid as usual.
COVID-19-related services should be assigned the appropriate COVID-19 ICD-10 diagnosis code. Coding guidance can be found on the CDC website. Cost-sharing waivers may not be applied to claims that do not include an appropriate COVID-19 ICD-10 diagnosis code.
Telephone E/M services should not be reported when the time spent on the telephone is captured in other services reported, such as:
- if CPT codes 99421-99423 have been reported by the same physician in the previous seven days for the same problem,
- when CPT codes 99339-99340 and 99374-99380 are used for the same call,
- during the same month with CPT codes 99487 and 99489, and
- when performed during the same service period at CPT codes 99495-99496.
Self-funded plans can develop their own policies and may opt out of some cost-sharing waivers. Similarly, Medicaid policies are established at the state-level. The AAFP recommends reaching out to your provider relations representatives or Medicare Administrative Contractors (MACs) to verify policies. The Center for Connected Health Policy is tracking COVID-19 Related State Actions.