CPT® Code 99443 is used to report a telephone evaluation and management (E/M) service provided to an established patient, parent, or guardian, lasting 21 to 30 minutes. This non-face-to-face service must be initiated by the patient and may involve discussion of health concerns, treatment management, or follow-up care.
This code is part of a trio (99441–99443) that differentiates telephone visits by length. It is intended for situations where an in-person or video visit is not necessary, but meaningful medical management is still provided over the phone.
Key facts about CPT Code 99443
- Type of service: Telephone E/M (not telehealth/video)
- Patient status: Established only
- Time requirement: 21–30 minutes of medical discussion
- Initiated by: Patient, parent, or guardian
- Includes:
- Assessment or management of a condition
- Review of test results
- Medication adjustments
- Lifestyle or symptom guidance
- Excludes: Services originating from a related E/M visit in the past 7 days or resulting in an in-person or telehealth visit within 24 hours (or next available)
When to use CPT Code 99443
Report 99443 when a physician or qualified healthcare professional provides a telephone consultation lasting 21 to 30 minutes with an established patient. The discussion must involve medical decision-making or management—not merely scheduling, lab reviews, or administrative topics.
The service must be:
- Documented in the patient’s medical record
- Clinically necessary
- Patient-initiated
- Not duplicated by other E/M services within the relevant time windows
This code supports continuity of care when in-person visits aren’t feasible or necessary, especially in integrative or concierge models.
Documentation requirements
To support proper billing and audit-readiness, documentation should include:
- Patient’s name and date/time of the call
- Duration of the call (must meet 21–30 minutes)
- Summary of the clinical issues discussed
- Medical decision-making or advice provided
- Any medication changes, orders, or follow-up instructions
- Confirmation that the service was patient-initiated and not related to a recent or upcoming E/M visit
Reimbursement and coding considerations
Reimbursement for 99443 varies by payer. While Medicare does not cover these codes under Part B, many commercial payers and Medicaid programs do, especially following expanded virtual care policies.
Tips to maximize reimbursement:
- Always document call duration and content
- Use appropriate ICD-10 codes to reflect medical necessity
- Confirm the payer’s policy on telephone E/M codes
- Do not bill if the call leads to an in-person or telehealth visit within 24 hours
How OptiMantra simplifies telephone visit billing
As more practices incorporate virtual and non-face-to-face care, OptiMantra’s EHR and practice management platform supports seamless documentation and billing for codes like 99443. With OptiMantra, you can:
- Document call duration and clinical content in structured templates
- Flag visits that qualify for telephone E/M coding
- Track time and link conversations directly to patient charts
- Generate clean claims with proper CPT modifiers and ICD-10 codes
- View payer-specific rules and pre-authorization statuses in one place
For integrative, concierge, and wellness-focused providers offering continuity care between visits, OptiMantra enables you to deliver high-value touchpoints without missing revenue opportunities.
Try OptiMantra for free here!
