New codes for responding to portal messages

The 2020 update to the Medicare Physician Fee Schedule includes six new codes that are part of the 2020 Current Procedural Terminology (CPT®) code set will help physicians and others report a range of digital health services including electronic visits through secure patient portal messages.

The new codes are spurred by digital health tools that are growing in popularity, such as patient portals. These tools enable patients and physicians to connect asynchronously and outside of face-to-face settings, making it easier for patients with transportation and scheduling barriers to get questions answered and receive care.

Physicians or other qualified health professionals who perform digital E/M services for a single patient for a total of 5 to 10 minutes within a seven-day period can report CPT code 99421, which carries an approximate Medicare payment of $15.50 in a nonfacility setting. For 11 to 20 minutes they can report code 99422, which carries an approximate payment of $31, and for more than 20 minutes they can report code 99423, for approximately $50.

To bill for these services, the patient must be established (though the problem may be new), the patient must be the one who initiates the services, and the problem must require a physician or other qualified health professional’s evaluation, assessment, and management.

Along with these six new, there are another 242 new CPT codes in the 2020 set approved by the CPT Editorial Panel, which considered broad input from physicians, medical specialty societies and the greater health care community. Two of these new codes also will enable patients to take part in their care while at home. Codes 99473 and 99474 have been added to support home blood-pressure monitoring that enables physicians to better diagnose and manage hypertension—and helps patients to take an active role in the process.

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