Chronic Care Management offers a continuous care to patients with two or more chronic conditions and since 2015, non face to face care is reimbursable under several codes. In January 2019, new internet consultation CPT codes went into effect that allow treating physicians or other qualified healthcare providers to bill for time spent on consulting with specialists on health matters requiring expertise, to assist with the diagnosis and/or management of the patient’s health. This is without the need for the patient’s face-to-face contact with the consulting physician or qualified healthcare professional.
In January 2019 the CMS unbundled four existing codes 99446-99449. By unbundling these codes the need for a specialist appointment was removed, and now codes 99446-99449 can be billed for as non face to face communication, such as phone or internet-based interactions between the treating physician (or qualified healthcare professional) and the consulting physician with specific expertise.
The CPT 99446 covers interprofessional telephone or internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified healthcare professional. This code requires 5-10 minutes of medical consultative discussion and review. The following codes cover the same service but are for longer periods of time: CPT 99447 requires 11-20 minutes of medical consultative discussion and review, CPT 99448 pays for 21-30 minutes of medical consultative discussion and review and CPT 99449 is for 31 minutes or more of medical consultative discussion and review.
The reimbursements are as follows:
CPT code 99446 (5-10 min) – $18.38
CPT code 99447 (11-20 min) – $36.40
CPT code 99448 (21-30 min) – $54.78
CPT code 99449 (31 min or more) – $73.16
Then, two new codes were added that address interprofessional internet consultation for CCM. These two new codes, CPT 99451 and 99452, add reimbursement for the treating provider’s efforts in initiating the consultation (which was not previously available).
CPT 99451 is for interprofessional telephone/internet/electronic health record assessment and management services provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified healthcare professional. It requires 5 or more minutes of medical consultative time. Code 99451 is reported by the consultant, allowing them to access data/information through the electronic health record (EHR), in addition to telephone or internet consultation. It should be noted that code 99451 doesn’t include any verbal interaction between practitioners and can be accomplished with only a written report. CPT code 99451 pays $37.48
CPT 99452 is for interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or qualified healthcare professional. It requires a minimum of 16 minutes and can be billed every 14 days when this time requirement is met. Code 99452 is reported by the requesting/treating physician/QHP (e.g., the primary care physician). CPT code 99452 pays $37.48
Consultant codes 99446-99449 and 99451:
- – can be reported for new or established patients
- – can be reported for a new or exacerbated problem
- – are reported only by a consultant when requested by another physician/QHP
- – cannot be reported more than once per seven days for the same patient
- – are not reported if the patient was seen by the consultant within the past 14 days
- – require verbal consent for the interprofessional consultation from the patient/family documented in the patient’s medical record
- – require that the request and the reason for the request for the consult be documented in the record
- – are not reported if a transfer of care or request for a face-to-face consult occurs as a result of the consultation within the next 14 days
- – are reported based on cumulative time spent, even if that time occurs on subsequent days
Requesting/treating physician/QHP code 99452:
- – is reported by the physician/QHP who is treating the patient and requesting the non-face-to-face consult for medical advice or opinion — and not for a transfer of care or a face-to-face consult
- – is reported only when the patient is not on-site and with the physician/QHP at the time of the consultation
- – cannot be reported more than once per 14 days per patient
- – includes time preparing for the referral and/or communicating with the consultant
- – can be reported with prolonged services, non-direct
- – requires a minimum of 16 minutes
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