Forget Medicare – but not private payers – for new phone/online codes

Why This Topic Matters

These services were newly introduced and immediately affected by Medicare payment policy, so practices needed to know whether the codes could be reported to Medicare, commercial payers, or patients. The article also highlights why payer policy, state licensure, and service initiation rules matter for real-world use.

Article Sections

1. Medicare coverage and payment outlook

   Discusses how Medicare addressed the new phone and online evaluation services in the 2008 fee schedule and why the payment outlook differed for other payers. It also touches on broader reimbursement implications and the role of relative value units.

2. Who may provide the service

   Reviews the distinction between physician and non-physician professional services and notes that provider qualifications depend on external policy sources. The section also references examples of professions discussed in the article.

3. General reporting considerations

   Summarizes the basic conditions described for reporting the phone and online evaluation services, including initiation, patient status, and timing-related exclusions. It also notes the relationship to prior and follow-up evaluation services and the earlier Category III code.