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BETA v.3.0

2025 CPT code 99443

Telephone evaluation and management service provided by a physician or other qualified healthcare professional to an established patient, parent, or guardian; 21-30 minutes of medical discussion.

This code should not be used if the telephone service leads to an E/M service within 24 hours. Time is the key factor for distinguishing between codes 99441, 99442, and 99443.

Modifiers may be applicable.

The telephone service must be medically necessary and appropriate for the patient's condition.

IMPORTANT:99441 (5-10 minutes), 99442 (11-20 minutes). Do not report 99441-99443 when using 99374-99380 for the same call(s). Do not report 99441-99443 for home and outpatient INR monitoring when reporting 93792, 93793. Do not report 99441-99443 during the same month with 99487-99489. Do not report 99441-99443 when performed during the service time of codes 99495 or 99496.

In simple words: This code covers a 21-30 minute phone call between a doctor or other qualified healthcare professional and an established patient (or their parent/guardian) to discuss a medical issue. The call can't be related to a visit within the last 7 days and can't result in an appointment within the next 24 hours.

This code represents a telephone-based evaluation and management (E/M) service provided by a physician or other qualified healthcare professional to an established patient, their parent, or guardian. The service involves 21-30 minutes of medical discussion. It cannot originate from a related E/M service provided within the previous 7 days, nor can it lead to an E/M service or procedure within the next 24 hours or soonest available appointment.

Example 1: An established patient calls their physician with a new complaint unrelated to any recent visits. During the 25-minute call, the physician gathers information about the symptoms, reviews the patient's medications, and provides medical advice. No appointment is scheduled., A parent calls their child's established pediatrician about a concerning rash. The pediatrician spends 22 minutes discussing the rash's appearance, the child's other symptoms, and potential treatment options. The pediatrician advises the parent to monitor the rash and call back if it worsens., A guardian of an established patient calls the patient's physician to discuss concerns about the patient's medication side effects. The physician spends 28 minutes reviewing the medication list, discussing the side effects, and adjusting the medication dosage.

Documentation must include the total time spent on the call, the content of the medical discussion, and the medical decision-making process.

** As of December 10, 2024, information on the payment status, historical fee schedule, NCCI edits, and modifier TC rules is not available from the provided sources.

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