CPT® Code 99442 is used to report a telephone evaluation and management (E/M) service provided by a physician or qualified healthcare professional to an established patient, parent, or guardian. The service involves 11–20 minutes of medical discussion, and is initiated by the patient, typically to address clinical concerns that do not require an in-person or telehealth visit.
This code reflects non-face-to-face time spent addressing patient questions, providing clinical advice, and supporting decision-making over the phone.
Key facts about CPT Code 99442
- Service type: Telephone E/M service
- Patient type: Established
- Duration: 11–20 minutes of medical discussion
- Provider type: Physician or qualified healthcare professional
- Initiated by: The patient or their caregiver
- Common uses:
- Medication management
- Test result discussion
- Follow-up care without need for a visit
- Behavioral health check-ins
- Chronic care management
When to use CPT Code 99442
CPT 99442 is appropriate when a patient initiates a call to discuss new or existing concerns that can be managed without an in-person, video, or portal-based encounter. The provider must spend at least 11 minutes on clinical discussion, and the call must not be:
- Related to an E/M service from the past 7 days
- Resulting in a scheduled E/M service within 24 hours or the soonest available slot
This service must involve medical decision-making and cannot be delegated to non-clinical staff.
Documentation requirements
To properly support CPT 99442, the provider must document:
- Date and time of the call
- Who initiated the service (must be patient or guardian)
- Chief concern and medical discussion summary
- Clinical advice or actions taken (e.g., medication change, monitoring plan)
- Start and stop time (or total time spent)
- Any referrals, prescriptions, or follow-ups initiated
Accurate documentation ensures that the service is medically necessary and separately billable.
Reimbursement and coding considerations
CPT 99442 is generally covered by commercial payers, particularly those that support telemedicine and virtual care. However, Medicare typically does not reimburse this code unless temporarily allowed through regulatory waivers or special programs.
Key points for coding:
- Use ICD-10 diagnosis codes that reflect the reason for the call (e.g., hypertension, anxiety, insomnia)
- Cannot be billed with another E/M service if within the 7-day/24-hour rule
- Not intended for administrative or non-clinical communication
Providers should verify payer-specific rules, especially regarding time thresholds and telehealth parity.
How OptiMantra streamlines telephone-based care
As practices increasingly adopt hybrid care models, platforms like OptiMantra help ensure that telephone encounters like those billed under CPT 99442 are efficiently delivered, documented, and reimbursed.
With OptiMantra, providers can:
- Track and log timed calls automatically in the patient chart
- Use templates for phone-based evaluations to ensure full compliance
- Flag encounters that meet time and content requirements for 99442
- Prevent coding errors by alerting providers to disqualifying E/M overlaps
- Sync notes, billing, and claims seamlessly in one integrated platform
Whether you’re supporting functional medicine patients, managing chronic conditions remotely, or offering follow-up care, OptiMantra makes it easy to capture the value of every clinical interaction—even by phone.
Try OptiMantra for free here!
