Early in 2004, the American Medical Association published a new CPT code 0074T that allowed physicians in the USA reimbursement for online consults. The new code was released January 1st, 2004.
* Code 0074T: Online evaluation & management service, per encounter, provided by a physician, using the Internet or similar electronic communications network, in response to a patient’s request, established patient.
In 2008, the CPT code 0074T was replaced. The code relating to online counseling was previously in the CPT manual under category III (emerging technologies). As of 2008, it has been replaced by the new code numbers and is now under category I.
CPT Code 98969 is used to describe online services provided by non physician. CPT code 98966 is used to bill for phone consultation services.
Here are the billing guidelines about these two codes. These two codes do not specify mental health-related services so the best advice is to check with the insurance carrier and advise your clients to do the same. For now it is best to assume that online counseling is not covered unless you can verify otherwise.
CPT 98969 On-Line Medical Evaluation by a Non-Physician
Online assessment and management service provided by a qualified non-physician health care professional to an established patient, guardian, or health care provider not originating from a related E/M service within the previous 7 days, using the Internet or similar electronic communications network.
- Reportable services involve a personal and timely response to the patient’s inquiry, and must include permanent storage (electronic or hard copy)
- The online encounter is reported only once for the same problem/issue during a seven-day period, and includes the sum of all communication related to the online encounter (eg telephone calls, prescriptions, lab orders).
- If the online encounter relates to and occurs within 7 days of another E/M service performed and reported by the same provider for the same problem, it is not separately reportable.
- If the online encounter relates to a procedure performed by the same physician and occurs during the global post-operative period, it is not separately reportable.
- Online services should not be reported for care plan oversight or anticoagulation management when the same communication is reported using codes 99339-99340, 99374-99380, or 99363-99364.
- Online services which result in a face-to-face visit for the same problem may be reported in addition to the face-to-face visit.
Example: A patient emails her physician to request information about cancer screening after learning that there is a history of breast, colon, and prostate cancer in close family members. The physician responds and explains the implications of the family history, reviews risk factors, and offers an opinion as to what types of screening may be appropriate. The physician may also direct the patient to informational websites or attach handouts that are routinely provided to patients.
Example: The mother of a 16 year old patient with cystic acne, controlled with topical medications, emails the physician because of a recent flare-up. She is concerned about scarring and desires information about other appropriate treatment options, and the impact of diet and stress on the condition. The physician responds to her concerns, offers a short course of antibiotic therapy, provides long-term treatment options, and instructions for a follow-up visit.
Telephone assessment and management service provided by a qualified nonphysician 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;
- 98966 5-10 minutes of medical discussion
- 98967 11-20 minutes of medical discussion
- 98968 21-30 minutes of medical discussion
- These codes may be reported only for established patients.
- The patient or patient’s parent/guardian must initiate the contact. These codes may not be used for calls initiated by a provider.
- Codes 99441-99443 are used only for services personally performed by a physician.
- Calls resulting in a face-to-face encounter for the same problem within 24 hours (or soonest available urgent appointment) are not reportable. Instead, consider the call part of the pre-service work for the billable E/M service.
- If the call relates to and occurs within 7 days of another E/M service performed and reported by the same provider for the same problem, the call is not reportable. This also means that a telephone call related to a previous call within 7 days is not reportable, since these codes are themselves an E/M service.
- Do not report a call that is related to and takes place within the postoperative period of a procedure performed by the same physician. These calls are considered to be part of the global surgical package.
- Telephone calls should not be reported for care plan oversight or anticoagulation management when the same communication is reported using codes 99339-99340, 99374-99380, or 99363-99364.
Updated May 31, 2012
Behavioral Health Innovation on Reimbursement: http://www.onlinecounselingplatforms.com/finances
Billing for phone and electronic sessions: http://www.acpinternist.org/ archives/2008/01/billing.htm
See P. 55, Appendix B – Listing of CPT Codes by Payer at Telemedicine Reimbursement Handbook: http://www.cteconline.org/_pdf/ Telemedicine-Reimbursement-Handbook.pdf
Medicare & Medicaid: Reimbursement of Telehealth: http://www.zurinstitute.com/telehealthresources.html#medicare
Telehealth Fact Sheet, (Search for “CPT” or “psychotherapy”) at http://www.telemedicine.com/pdfs/ TelehealthSrvcsfctsht.pdf
Reimbursement of online therapy: http://issuu.com/onlinetherapyinstitute/ docs/tilt_issue5_final/56