Are Patient/Family/Caregiver Phone Calls A Billable Service?

As a provider, we know that we receive many phone calls from patients demanding to speak with their doctor and that they don't want to wait until their appointments. 

As a busy provider, this can be tedious because most of the time these patients as us many questions that takes time away from documentation or other To Do's and many times we do this for free. 

BUT, although not famously known, 

Providers can bill for audio-only visits with established patients using the following CPT codes. 

✅ Reimbursement Conditions 

To bill these codes when:

 • The patient is established 

 • The issue is not relate to a visit in the past 7 days 

 • The call does not lead to an in-person or telehealth visit within the next 24 hours 

 • Clear documentation of time and medical decision-making is required.

🔄 Alternate Codes Used by Some Payers 

Some Medicare Advantage or Medicaid plans may use:

These are typically for virtual communication not requiring full E/M service.

The average reimbursement rate for these codes is about $17 to $35 so at least it somewhat compensates provides for the time they take to speak to patients on the phone but again, certain conditions must apply in order to obtain reimbursement.  

To implement this, I recommend to consult with your billing specialist or revenue cycle manager to determine which codes are appropriate for your practice and patients.

Coverage may vary by payer, state, and contract type, and some insurance plans may not reimburse for phone-only visits at all, which as states in our courses; we stress the importance of performing insurance eligibility PRIOR to performing services to make sure you are not working and billing in vain.