Alliance Brand A

Update to Telephone/Telephonic Services originally posted on March 17

The Telephonic codes have been updated to provider contract details for Medicaid in Alpha for providers that currently have Outpatient and/or E&M codes in their contract. The codes are currently effective March 13, 2020-April 30, 2020. Due to the short term nature of the codes the codes were placed in ONLY the providers main site location, please submit all billing for these codes under your main site as identified in your Alpha contract details. We are currently working on adding these codes to applicable State contracts(those that have OPT & E&M) and will send out a notification when to submit any State billing for these codes in order to reduce any billing denials.

Licensed clinicians and prescribers within the Alliance network 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. A rate for these services has not been finalized but as soon as possible we will add established rates to the codes and make them 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. 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.

Click here for a PDF version of this update.

 



Page last modified: March 24, 2020