Telephone visits, e-visits and hosted visits

Applies to:

Commercial group HMO, EPO, POS and PPO plans
Commercial individual MyPriority® plans
Priority Health Choice plans (Medicaid and Healthy Michigan Plan)
Priority Health Medicare plans

Definition:

Priority Health reimburses, fee for service, for telephone visits, e-visits and hosted visits. The CPT manual defines billing and coding requirements for both the physician and the non-physician qualified health care provider* (QHP) visit.

  • No modifier is necessary to bill these codes
  • Copay and deductible may apply

Medicare billing

Medicare considers these a "supplemental benefit." An e-visit cannot be used as a substitute for an effective, ongoing doctor-patient relationship, but is supportive of that relationship and of efficient delivery of care.

  • Copay and deductible may apply, depending on the member's Priority Health Medicare plan, for phone/online visit codes 99441, 99442, 99443 and 99444.
  • An e-visit must be fully documented in the member's record by the provider who performed it.
  • The provider must share that documentation with the member's primary care provider and/or other plan provider specified by the member.

Medicaid and Healthy Michigan Plan billing

Refer to the Medicaid fee schedules to determine if telephone, e-visit or hosted visits are payable services. Go to Medicaid Fee Schedules.

Reimbursement rates

The reimbursement rates for these codes are listed in our standard fee schedules for your contract.

See our standard fee schedules

Visit codes billable by physicians only

Hosted visits

A "hosted" visit is a virtual consult with a remote physician, hosted by a physician who is face-to-face with the patient. Telephone, teleconference, REMEC and other systems may be used.

  • G0406, Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth
  • G0407, Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth
  • G0408, Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth
  • G0425, Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth
  • G0426, Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth
  • G0427, Telehealth consultation, emergency department or initial inpatient, typically 70 minutes communicating with the patient via telehealth

Visit codes billable by physicians and QHPs*

Telephone visits

  • 99441, Telephone evaluation and management service by a physician or other qualified health care professional who may report E&M services provided to an established patient, parent or guardian not originating from a related assessment and management service provided within the previous 7 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
  • 99442, Telephone services (see above), 11-20 minutes of medical discussion
  • 99443, Telephone services (see above), 21-30 minutes of medical discussion
  • Bill the non-physician QHP telephone visit under the participating PCP.
  • A participating physican needs to be available to the QHP at the time of the telephone visit. "Available" can mean face-to-face, by phone, or by fax.
  • QHPs may only assess patients within the scope of their licensure.
  • When the patient initiates the call and the physician or QHP returns the patient's call, it should be documented that way in the medical record.
  • Copayments will not apply.

Online medical evaluations ("e-visits")

  • 99444, Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E&M service provided within the previous 7 days, using the Internet or similar electronic communications network.
  • Do not report 99444 when using 99339-99340, 99374-99380 for the same communication or for anticoagulation management when reporting 99363, 99364.
  • 98969, Online assessment and management services provided by a qualified non-physician health care professional to an established patient, guardian, or health care provider not originating from a related assessment and management service provided within the previous 7 days, using the internet or similar electronic communications network.
  • You must use encrypted or authenticated email for online medical evaluation visits. Standard email is not acceptable, since it is not secure, has no "terms of use" or legal disclaimers in place to protect the provider, and can easily expose patient PHI including email addresses to unintended third parties.
  • Copayments will apply.

Visit codes billable by QHPs*

Telephone assessment codes are not billable for Medicare plans.

  • 98966, Telephone assessment and management service provided by a qualified non-physician health care professional* to an established patient, parent or guardian; 5-10 minutes of medical discussion
  • 98967, Telephone assessment (see above), 11-20 minutes of medical discussion
  • 98968, Telephone assessment (see above), 21-30 minutes of medical discussion
  • 98969, Online assessment and management service provided by a qualified non-physician health care professional to an established patient or guardian, not originating from a related assessment and management service provided within the previous 7 days, using the Internet or similar electronic communications network

Also see Care management billing for details on the unique processing of QHP telephone visit codes.

*QHPs are credentialed by Priority Health. They include RNs, certified NPs, PA-Cs, licensed Masters social workers (LMSWs), psychologists (LLPs and PhDs), certified diabetes educators (CDEs), registered dieticians and Masters'- trained nutritionists, clinical pharmacists and respiratory therapists.