Attention: Primary Care Providers Telephonic Evaluation and Management for Influenza Effective February 26, 2018

In response to the higher than normal number of influenza cases and influenza-related complications and deaths, the Division of Medical Assistance (DMA) is offering telephonic evaluation and management services to beneficiaries who are actively experiencing flu-like symptoms. The purpose of this service is to assist primary care providers assessing established patients over the telephone to gather additional information.

Telephonic evaluation and management services must be rendered by a physician, nurse practitioner, or physician assistant actively enrolled in NC Medicaid and NCTracks. Services are only to be rendered to established patients or legal guardian of an established patient.

Telephonic evaluation and management services are not to be billed if clinical decision making dictates a need to see the beneficiary within 24 hours for an office visit or next available appointment; the telephone consultation shall be considered a part of the office visit. If the telephone call follows an office visit performed and reported within the past seven calendar days for the same diagnosis, then the telephone services are considered part of the previous office visit and are not separately billed.

CPT Codes to be reported for telephonic evaluation and management services include:

99441: Telephone evaluation and management service by a physician or other qualified healthcare professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 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: 11-20 minutes of medical discussion

99443: 21-30 minutes of medical discussion
 
ICD-10 diagnosis codes to be reported with telephonic evaluation and management services include:

Z20.828: Contact with and (suspected) exposure to other viral communicable disease.

Dates of service for reporting of telephonic evaluation and management codes coincide with the annual flu season. Claims for telephonic calls related to flu-like illness will be denied for dates of service after April 30, 2018. Providers may be subject to post-payment review.

Rates for the new service have been posted on the DMA website under Provider Fee Schedules.

*This is a copy of the Medicaid Special Bulletin, Influenza Telephone Evaluation